Provider Demographics
NPI:1679160279
Name:JONES, STEVEN STANLEY
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:STANLEY
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51615 T.R. 224
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:OH
Mailing Address - Zip Code:43824-9028
Mailing Address - Country:US
Mailing Address - Phone:740-545-0886
Mailing Address - Fax:
Practice Address - Street 1:51615 T.R. 224
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:OH
Practice Address - Zip Code:43824-9028
Practice Address - Country:US
Practice Address - Phone:740-545-0886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3069898Medicaid