Provider Demographics
NPI:1265601421
Name:VICKI D JONES
Entity type:Organization
Organization Name:VICKI D JONES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:D
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-236-0886
Mailing Address - Street 1:606 FIFTH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-6618
Mailing Address - Country:US
Mailing Address - Phone:903-236-0886
Mailing Address - Fax:903-236-9786
Practice Address - Street 1:606 FIFTH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-6618
Practice Address - Country:US
Practice Address - Phone:903-236-0886
Practice Address - Fax:903-236-9786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0102755332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX533244OtherBCBS
TX010160201Medicaid
TX0521340002Medicare NSC