Healthcare Provider Details

I. General information

NPI: 1336323757
Provider Name (Legal Business Name): MR. JEROME T JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1461 25TH ST SE
SAINT CLOUD MN
56304-9500
US

IV. Provider business mailing address

1461 25TH ST SE
SAINT CLOUD MN
56304-9500
US

V. Phone/Fax

Practice location:
  • Phone: 320-282-1809
  • Fax: 320-230-2042
Mailing address:
  • Phone: 320-282-1809
  • Fax: 320-230-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: