Provider Demographics
NPI:1740476860
Name:JONATHAN JACOBS MD LLC
Entity type:Organization
Organization Name:JONATHAN JACOBS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-451-8500
Mailing Address - Street 1:12140 NALL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2503
Mailing Address - Country:US
Mailing Address - Phone:913-451-8500
Mailing Address - Fax:913-451-8526
Practice Address - Street 1:12140 NALL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2503
Practice Address - Country:US
Practice Address - Phone:913-451-8500
Practice Address - Fax:913-451-8526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center