Provider Demographics
NPI:1689769903
Name:JONES FAMILY MEDICINE CLINIC, PLLC
Entity Type:Organization
Organization Name:JONES FAMILY MEDICINE CLINIC, PLLC
Other - Org Name:BAY SPRINGS MEDICAL CLINIC, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAYE
Authorized Official - Middle Name:D
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-425-0092
Mailing Address - Street 1:2680 HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:BAY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39422-7429
Mailing Address - Country:US
Mailing Address - Phone:601-764-6972
Mailing Address - Fax:601-764-6975
Practice Address - Street 1:2680 HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:BAY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39422-7429
Practice Address - Country:US
Practice Address - Phone:601-764-6972
Practice Address - Fax:601-764-6975
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JONES FAMILY MEDICINE CLINIC, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC03334Medicare ID - Type Unspecified
MS07728885Medicaid