1124461298 NPI number — DAVID B JONES MSW, CAC III

Table of content: (NPI 1437498854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124461298 NPI number — DAVID B JONES MSW, CAC III

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
DAVID
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, CAC III
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:
1124461298
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 CRESTRIDGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80525-3934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-494-9761
Provider Business Mailing Address Fax Number:
970-346-9800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2114 MIDPOINT DR UNIT 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80525-4324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-372-3144
Provider Business Practice Location Address Fax Number:
970-482-1921
Provider Enumeration Date:
04/09/2013

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: 101YA0400X , with the licence number:  ACC-6491 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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