1093864480 NPI number — NATHAN JONES DO

Table of content: NATHAN JONES DO (NPI 1093864480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093864480 NPI number — NATHAN JONES DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
NATHAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093864480
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6411 PINE HOLLOW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48823-9737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-567-9835
Provider Business Mailing Address Fax Number:
269-567-9841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 E MICHIGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48912-1811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-567-9835
Provider Business Practice Location Address Fax Number:
269-567-9841
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  429 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: 5101020311 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 320G410340 . This is a "BCBS GROUP ID" identifier . This identifiers is of the category "OTHER".




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