Healthcare Provider Details

I. General information

NPI: 1003811530
Provider Name (Legal Business Name): KEVIN S. JONES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 05/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 SW 44TH ST
OKLAHOMA CITY OK
73119-3339
US

IV. Provider business mailing address

3201 INDUSTRIAL TERRACE #130
AUSTIN TX
78758-7525
US

V. Phone/Fax

Practice location:
  • Phone: 405-682-2222
  • Fax: 405-682-2226
Mailing address:
  • Phone: 512-458-4589
  • Fax: 512-458-9521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. JUSTIN YULE
Title or Position: VICE PRESIDENT
Credential:
Phone: 512-458-4589