Healthcare Provider Details

I. General information

NPI: 1245942549
Provider Name (Legal Business Name): MATTHEW JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 COLLEGE ST
BATTLE CREEK MI
49037-3432
US

IV. Provider business mailing address

175 COLLEGE ST
BATTLE CREEK MI
49037-3432
US

V. Phone/Fax

Practice location:
  • Phone: 269-966-1460
  • Fax: 269-966-2844
Mailing address:
  • Phone: 269-966-1460
  • Fax: 269-966-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: