Provider Demographics
NPI:1043306608
Name:LARRY JONES MD INC
Entity Type:Organization
Organization Name:LARRY JONES MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-224-4439
Mailing Address - Street 1:PO BOX 75
Mailing Address - Street 2:
Mailing Address - City:ROARING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:16673
Mailing Address - Country:US
Mailing Address - Phone:814-224-4439
Mailing Address - Fax:814-224-5930
Practice Address - Street 1:99 NASON DRIVE
Practice Address - Street 2:
Practice Address - City:ROARING SPRING
Practice Address - State:PA
Practice Address - Zip Code:16673
Practice Address - Country:US
Practice Address - Phone:814-224-4439
Practice Address - Fax:814-224-5930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA502685OtherBLUE SHIELD
PAG88904Medicare UPIN
126850Medicare PIN
PA0550830001Medicare NSC
PA502685OtherBLUE SHIELD