Provider Demographics
NPI:1619209293
Name:CHARLES JONES JR MD PA
Entity Type:Organization
Organization Name:CHARLES JONES JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:870-339-5006
Mailing Address - Street 1:211 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HUGHES
Mailing Address - State:AR
Mailing Address - Zip Code:72348-9704
Mailing Address - Country:US
Mailing Address - Phone:870-339-5006
Mailing Address - Fax:
Practice Address - Street 1:211 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HUGHES
Practice Address - State:AR
Practice Address - Zip Code:72348-9704
Practice Address - Country:US
Practice Address - Phone:870-339-5006
Practice Address - Fax:833-415-0351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5115207P00000X, 207Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR168502001Medicaid
AR168502001Medicaid