Provider Demographics
NPI:1710964622
Name:JOHN O JONES MD PSC
Entity Type:Organization
Organization Name:JOHN O JONES MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:O
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-836-8086
Mailing Address - Street 1:1108 POWELL LANE
Mailing Address - Street 2:
Mailing Address - City:FLATWOODS
Mailing Address - State:KY
Mailing Address - Zip Code:41139-1614
Mailing Address - Country:US
Mailing Address - Phone:606-836-8086
Mailing Address - Fax:606-836-3743
Practice Address - Street 1:1108 POWELL LANE
Practice Address - Street 2:
Practice Address - City:FLATWOODS
Practice Address - State:KY
Practice Address - Zip Code:41139-1614
Practice Address - Country:US
Practice Address - Phone:606-836-8086
Practice Address - Fax:606-836-3743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13008207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000045529OtherANTHEM
000000045529OtherANTHEM
1221701Medicare ID - Type Unspecified