1821760026 NPI number — JONES FAMILY MEDICINE CLINIC, PLLC

Table of content: SARAH J PETERS (NPI 1114175742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821760026 NPI number — JONES FAMILY MEDICINE CLINIC, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JONES FAMILY MEDICINE 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:
1821760026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 CIRCLE J DR STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39440-1981
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-425-0092
Provider Business Mailing Address Fax Number:
601-425-0473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUITMAN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39355-2119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-425-0092
Provider Business Practice Location Address Fax Number:
601-425-0473
Provider Enumeration Date:
10/05/2021

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
KAYE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
601-425-0092

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0876882 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com