Provider Demographics
NPI:1689907131
Name:JOE V. JONES MD, PA.
Entity Type:Organization
Organization Name:JOE V. JONES MD, PA.
Other - Org Name:INTERNAL MEDICINE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRIMARY DOCTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:V
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:870-763-1520
Mailing Address - Street 1:605 N 2ND ST
Mailing Address - Street 2:BLYTHEVILLE
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-2034
Mailing Address - Country:US
Mailing Address - Phone:870-763-1520
Mailing Address - Fax:870-762-2370
Practice Address - Street 1:605 N 2ND ST
Practice Address - Street 2:BLYTHEVILLE
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-2034
Practice Address - Country:US
Practice Address - Phone:870-763-1520
Practice Address - Fax:870-762-2370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN-5634174400000X
ARA01707 ANP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR52726Medicare UPIN