1346246899 NPI number — MRS. DEB L JONES OTR L

Table of content: MRS. DEB L JONES OTR L (NPI 1346246899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346246899 NPI number — MRS. DEB L JONES OTR L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
DEB
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR L
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:
1346246899
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1337 GUSDORF RD
Provider Second Line Business Mailing Address:
STE G
Provider Business Mailing Address City Name:
TAOS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87571-6297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-758-4337
Provider Business Mailing Address Fax Number:
575-751-1890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1337 GUSDORF RD
Provider Second Line Business Practice Location Address:
STE G
Provider Business Practice Location Address City Name:
TAOS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87571-6297
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-758-4337
Provider Business Practice Location Address Fax Number:
575-751-1890
Provider Enumeration Date:
06/21/2005

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: 225X00000X , with the licence number:  888 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10015013 . This is a "LOVELACE HEALTH PLAN PROV" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 0368860 . This is a "CIGNA PROV #" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: NM00N647 . This is a "BLUECROSS PROV #" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 201079915 . This is a "PRESBYTERIAN PROVIDER #" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 68973276 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: B4412 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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