1376518522 NPI number — EVERETTE GARNETT JONES MD

Table of content: EVERETTE GARNETT JONES MD (NPI 1376518522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376518522 NPI number — EVERETTE GARNETT JONES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
EVERETTE
Provider Middle Name:
GARNETT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1376518522
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 17951
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOLDEN
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80402-6032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2005 FRANKLIN ST
Provider Second Line Business Practice Location Address:
SUITE 490
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80205-5412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-894-9800
Provider Business Practice Location Address Fax Number:
303-894-9805
Provider Enumeration Date:
02/21/2006

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: 207R00000X , with the licence number:  18166 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RG0100X , with the licence number: 18166 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01181668 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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