1346446705 NPI number — JONES FAMILY MEDICAL CLINIC, PLLC

Table of content: (NPI 1346446705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346446705 NPI number — JONES FAMILY MEDICAL CLINIC, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JONES FAMILY MEDICAL CLINIC, PLLC
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:
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:
1346446705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 N GLOSTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUPELO
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38804-1206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-840-0990
Provider Business Mailing Address Fax Number:
662-840-0182

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 N GLOSTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUPELO
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38804-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-840-0990
Provider Business Practice Location Address Fax Number:
662-840-0182
Provider Enumeration Date:
06/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALLRED
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
662-840-0990

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1346446705 . This is a "NPI JONES FAMILY MEDICAL CLINIC, PLLC" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 302G080670 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 080002925 . This is a "MEDICARE PTAN PHIL JONES INDIVIDUAL" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 00015920 . This is a "MEDICAID INDIVIDUAL PHIL JONES" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 12788 . This is a "PHILLIP JONES, MD LISCENS" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 1770636243 . This is a "NPI TAMMIE WATERS INDIVIDUAL" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 425198301A . This is a "JONES BCBS" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 001204741 . This is a "MEDICAID TAMMIE WATERS INDIVIDUAL" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: P01004732 . This is a "RAILROAD MEDICARE TAMMIE WATERS IND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 09015894 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: DS1903 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: R574929 . This is a "LISCENSE TAMMIE WATERS" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 080136332 . This is a "RAILROAD MEDICARE PTAN PHIL JONES" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 1659399723 . This is a "JONES NPI INDIVIDUAL" identifier . This identifiers is of the category "OTHER".




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