Healthcare Provider Details

I. General information

NPI: 1689726168
Provider Name (Legal Business Name): MARK E JONES HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 PORT AU PRINCE ROAD 1204 TREASURE LAKE
DU BOIS PA
15801
US

IV. Provider business mailing address

1204 TREASURE LK
DU BOIS PA
15801-9029
US

V. Phone/Fax

Practice location:
  • Phone: 814-371-2601
  • Fax:
Mailing address:
  • Phone: 814-371-2601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberF02405
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1626
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: