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General NPI Number Information
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NPI Number | 1902638893
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Entity Type | Organization
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Legal Business Name | MEDI-CONNECT
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Dates
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Enumeration Date | 08/19/2024
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 4140 JACKIE RD SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-6624
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Country | US
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Telephone | 505-477-4714
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Fax |
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Provider Business Mailing Address
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Address Line | 4140 JACKIE RD SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-6624
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Country | US
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Telephone | 505-477-4714
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDWARD LIDALE JONES
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Credential |
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Telephone | 619-254-0547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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