MEDICARE: MRS. SYLVIA D JONES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier	C17478	TX

General Provider Information

NPI Number	:	1487831806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SYLVIA D JONES

Provider Business Mailing Address
First Line	:	6231 OAKMONT BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-2812
Country	:	US
Telephone Number	:	817-361-1344
Fax Number	:	817-361-1347

Provider Business Practice Location Address
First Line	:	6231 OAKMONT BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-2812
Country	:	US
Telephone Number	:	817-361-1344
Fax Number	:	817-361-1347

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	11/11/2008

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