1780190470 NPI number — BLAIR JORDAN JONES P.T.A.

Table of content: BLAIR JORDAN JONES P.T.A. (NPI 1780190470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780190470 NPI number — BLAIR JORDAN JONES P.T.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
BLAIR
Provider Middle Name:
JORDAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLOOMFIELD
Provider Other First Name:
BLAIR
Provider Other Middle Name:
JORDAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780190470
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 CHARLES PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANHATTAN
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66502-2750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-537-4200
Provider Business Mailing Address Fax Number:
785-537-4354

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8231 POSITANO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-4882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-564-4699
Provider Business Practice Location Address Fax Number:
785-775-1373
Provider Enumeration Date:
12/18/2017

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: 225200000X , with the licence number:  14-02939 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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