1831527936 NPI number — PHILIP JONES LSW

Table of content: PHILIP JONES LSW (NPI 1831527936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831527936 NPI number — PHILIP JONES LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
PHILIP
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSW
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:
1831527936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
61 N WILLOW ST
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
MESQUITE
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89027-4785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-346-4696
Provider Business Mailing Address Fax Number:
702-346-4699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
61 N WILLOW ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
MESQUITE
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89027-4785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-346-4696
Provider Business Practice Location Address Fax Number:
702-346-4699
Provider Enumeration Date:
10/29/2013

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: 104100000X , with the licence number:  2087-S , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X , with the licence number: 2087-S , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225C00000X , with the licence number: 2087-S , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 88-6000022 . This is a "STATE OF NEVADA" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".