MEDICARE: VIVIAN MICHELLE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1891326922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN MICHELLE JONES

Provider Business Mailing Address
First Line	:	920 S 6TH ST
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62220-2453
Country	:	US
Telephone Number	:	314-327-3631
Fax Number	:

Provider Business Practice Location Address
First Line	:	4618 BESSIE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-2424
Country	:	US
Telephone Number	:	314-327-3631
Fax Number	:

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

Provider Enumeration Date	:	01/28/2020
Last Update Date	:	01/28/2020

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Directions to “ VIVIAN MICHELLE JONES ” Practice Location

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