Provider Demographics
NPI:1346446705
Name:JONES FAMILY MEDICAL CLINIC, PLLC
Entity Type:Organization
Organization Name:JONES FAMILY MEDICAL CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALLRED
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT
Authorized Official - Phone:662-840-0990
Mailing Address - Street 1:1200 N GLOSTER ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-1206
Mailing Address - Country:US
Mailing Address - Phone:662-840-0990
Mailing Address - Fax:662-840-0182
Practice Address - Street 1:1200 N GLOSTER ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-1206
Practice Address - Country:US
Practice Address - Phone:662-840-0990
Practice Address - Fax:662-840-0182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1346446705OtherNPI JONES FAMILY MEDICAL CLINIC, PLLC
MS302G080670OtherMEDICARE PTAN
MS080002925OtherMEDICARE PTAN PHIL JONES INDIVIDUAL
MS00015920OtherMEDICAID INDIVIDUAL PHIL JONES
MS12788OtherPHILLIP JONES, MD LISCENS
MS1770636243OtherNPI TAMMIE WATERS INDIVIDUAL
MS425198301AOtherJONES BCBS
MS001204741OtherMEDICAID TAMMIE WATERS INDIVIDUAL
P01004732OtherRAILROAD MEDICARE TAMMIE WATERS IND
MS09015894Medicaid
MSDS1903OtherRAILROAD MEDICARE GROUP
MSR574929OtherLISCENSE TAMMIE WATERS
MS080136332OtherRAILROAD MEDICARE PTAN PHIL JONES
1659399723OtherJONES NPI INDIVIDUAL
MSC68910Medicare UPIN
MS00015920OtherMEDICAID INDIVIDUAL PHIL JONES