1700201555 NPI number — LASHELL JONES

Table of content: LASHELL JONES (NPI 1700201555)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700201555 NPI number — LASHELL JONES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
LASHELL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1700201555
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5470 ORIOLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63120-2412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-755-1166
Provider Business Mailing Address Fax Number:
314-755-1177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8401 LATTY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAZELWOOD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63042-3214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-616-1268
Provider Business Practice Location Address Fax Number:
314-942-1337
Provider Enumeration Date:
03/03/2014

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: 374U00000X , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 21781656 . This is a "TIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 38-3896672 . This is a "FEDERAL IDENTIFICATION NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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