Provider Demographics
NPI:1083748032
Name:EDITH A. JONES-POLAND MD PROFESSIONAL CORP
Entity Type:Organization
Organization Name:EDITH A. JONES-POLAND MD PROFESSIONAL CORP
Other - Org Name:EDITH A. JONES-POLAND MD AND ASSOC. INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JONES-POLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-401-2502
Mailing Address - Street 1:56925 YUCCA TRL
Mailing Address - Street 2:NUMBER 232
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-7913
Mailing Address - Country:US
Mailing Address - Phone:760-401-2502
Mailing Address - Fax:
Practice Address - Street 1:56925 YUCCA TRL
Practice Address - Street 2:NUMBER 232
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-7913
Practice Address - Country:US
Practice Address - Phone:760-401-2502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76482208D00000X, 208D00000X, 208D00000X
CA17324363LF0000X
CA10756363LF0000X
CA51391363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH56245Medicare UPIN
CAZZZ04720ZMedicare PIN