Provider Demographics
NPI:1760685507
Name:JONES FAMILY PRACTICE
Entity Type:Organization
Organization Name:JONES FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:MANDEVILLE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:785-594-6412
Mailing Address - Street 1:810 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66006-3101
Mailing Address - Country:US
Mailing Address - Phone:785-594-6412
Mailing Address - Fax:785-594-3599
Practice Address - Street 1:810 HIGH ST
Practice Address - Street 2:
Practice Address - City:BALDWIN CITY
Practice Address - State:KS
Practice Address - Zip Code:66006-3101
Practice Address - Country:US
Practice Address - Phone:785-594-6412
Practice Address - Fax:785-594-3599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-12996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110065Medicare ID - Type Unspecified