Basic Information
| Provider Information | |||||||||
| NPI: | 1487091997 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | WAYNE | ||||||||
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| Credential: | RPA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 S BROWN ST | ||||||||
| Address2: | P.O. BOX 905 | ||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492031428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177832612 | ||||||||
| FaxNumber: | 5177836095 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 N EAST AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492011753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177884800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2013 | ||||||||
| LastUpdateDate: | 05/24/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 243U00000X | Y | Technologists, Technicians & Other Technical Service Providers | Radiology Practitioner Assistant | 247100000X | N | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | 2471C3401X | N | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Computed Tomography |
No ID Information.