Provider Demographics
NPI: | 1457353955 |
---|---|
Name: | JONES, TERESA L (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | TERESA |
Middle Name: | L |
Last Name: | JONES |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 129 |
Mailing Address - Street 2: | |
Mailing Address - City: | GREENFIELD |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46140-0129 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 317-468-6270 |
Mailing Address - Fax: | 317-468-6268 |
Practice Address - Street 1: | 300 E BOYD AVE STE 120 |
Practice Address - Street 2: | |
Practice Address - City: | GREENFIELD |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46140-2832 |
Practice Address - Country: | US |
Practice Address - Phone: | 317-462-3441 |
Practice Address - Fax: | 317-477-6316 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-08-15 |
Last Update Date: | 2010-10-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 01034366A | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 200311740B | Medicaid | |
IN | 000000175374 | Other | ANTHEM PIN# |
IN | 080165765 | Other | MEDICARE RAILROAD # |
IN | 4103311 | Other | AETNA PIN# |
IN | 200048090 | Medicaid | |
IN | E05357 | Medicare UPIN | |
IN | 200048090 | Medicaid |