1154347714 NPI number — THE JONES CLINIC, PC

Table of content: (NPI 1154347714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154347714 NPI number — THE JONES CLINIC, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE JONES CLINIC, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
C. MICHAEL JONES, MD, PC
Provider Other Organization Name Type Code:
4
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:
1154347714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7710 WOLF RIVER CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38138-1734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-685-5969
Provider Business Mailing Address Fax Number:
901-685-6424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 DOCTORS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ALBANY
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38652-3109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-538-5526
Provider Business Practice Location Address Fax Number:
662-534-2882
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HATFIELD
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
R
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
901-685-5969

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 09015323 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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