Healthcare Provider Details

I. General information

NPI: 1295741981
Provider Name (Legal Business Name): JARED W. JONES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 ENTERPRISE DR
ANDERSON IN
46013-9684
US

IV. Provider business mailing address

3600 W BETHEL AVE
MUNCIE IN
47304-5407
US

V. Phone/Fax

Practice location:
  • Phone: 765-683-4400
  • Fax: 765-213-3713
Mailing address:
  • Phone: 800-622-6575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number01039210A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100455565
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerRAILROAD MEDICARE
# 2
Identifier100455565
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer
# 3
Identifier000000087012
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerANTHEM PIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: