1295707099 NPI number — JUDY LEE JONES MD

Table of content: JUDY LEE JONES MD (NPI 1295707099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295707099 NPI number — JUDY LEE JONES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
JUDY
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARMOUR
Provider Other First Name:
JUDY
Provider Other Middle Name:
JONES
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1295707099
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 S WOODRUFF
Provider Second Line Business Mailing Address:
SUITE 19
Provider Business Mailing Address City Name:
IDAHO FALLS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-529-2603
Provider Business Mailing Address Fax Number:
208-529-0451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 S WOODRUFF
Provider Second Line Business Practice Location Address:
SUITE 19
Provider Business Practice Location Address City Name:
IDAHO FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-529-2603
Provider Business Practice Location Address Fax Number:
208-529-0451
Provider Enumeration Date:
02/06/2006

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: 207Q00000X , with the licence number:  M4671 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000010005844 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 46714 . This is a "BLUE CROSS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000384000 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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