Provider Demographics
NPI:1780772475
Name:MCLEAN JONES PODIATRY CORP.
Entity type:Organization
Organization Name:MCLEAN JONES PODIATRY CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:559-438-0283
Mailing Address - Street 1:PO BOX 27195
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-7195
Mailing Address - Country:US
Mailing Address - Phone:559-438-0283
Mailing Address - Fax:559-438-9201
Practice Address - Street 1:6335 N FRESNO ST STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5272
Practice Address - Country:US
Practice Address - Phone:559-438-0283
Practice Address - Fax:559-438-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3875332B00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ45038ZOtherBLUE SHIELD PROVIDER #
CAGRE001120Medicaid
CA000E38750OtherBLUE CROSS OF CALIFORNIA
CAGRE001120Medicaid
ND5725140001Medicare NSC
CAZZZ13683ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER #