Provider Demographics
NPI:1386848315
Name:GEORGE T. JONES M.D.S.C
Entity Type:Organization
Organization Name:GEORGE T. JONES M.D.S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:JONES
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:815-725-4566
Mailing Address - Street 1:2112 W JEFFERSON ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6663
Mailing Address - Country:US
Mailing Address - Phone:815-725-4566
Mailing Address - Fax:815-725-5351
Practice Address - Street 1:2112 W JEFFERSON ST
Practice Address - Street 2:SUITE 222
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6663
Practice Address - Country:US
Practice Address - Phone:815-725-4566
Practice Address - Fax:815-725-5351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36056701208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36056701Medicaid
ILA36290Medicare UPIN
IL36056701Medicaid