1659470151 NPI number — DR. LARHONDA R JONES M.D.

Table of content: DR. LARHONDA R JONES M.D. (NPI 1659470151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659470151 NPI number — DR. LARHONDA R JONES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
LARHONDA
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1659470151
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3394 MCKELVEY RD
Provider Second Line Business Mailing Address:
STE. 116
Provider Business Mailing Address City Name:
BRIDGETON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63044-2531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-209-0900
Provider Business Mailing Address Fax Number:
314-209-0912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3394 MCKELVEY RD
Provider Second Line Business Practice Location Address:
STE. 116
Provider Business Practice Location Address City Name:
BRIDGETON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63044-2531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-209-0900
Provider Business Practice Location Address Fax Number:
314-209-0912
Provider Enumeration Date:
09/21/2006

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: 2084P0804X , with the licence number:  109665 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0804X , with the licence number: 036-097194 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 481375 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 15-44745 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 370760015JON . This is a "PREMIERE BENEFITS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 889413 . This is a "MERCY CARE PLUS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 036097194 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 370760015JON . This is a "MERCY HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 370760015JON . This is a "UNITY HEALTH SERVICES" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 479955 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: P1505 . This is a "PAS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 127583 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 889413 . This is a "NOVASYS HEALTH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 15-44745 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 260205000 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 481375 . This is a "MH/SA CLAIMS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 7769381 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 203982012 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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