Active NPI
Jack Edward Jones II
- Home Modifications Contractor
- Rancho Mirage, CA
National Provider Identifier
1699948083
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Modifications Contractor
- License
- 482707
- Practice address
- 90 Lake Shore Dr
Rancho Mirage, CA 92270-4054 - Phone
- (760) 469-3208
- NPI assigned
- Apr 8, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Modifications Contractor | 171WH0202X | 482707 | CA | Primary |
Addresses
Primary practice location
90 Lake Shore Dr
Rancho Mirage, CA 92270-4054
Mailing address
90 Lakeshore Dr.
Rancho Mirage, CA 92270
Phone (760) 469-3208
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 482707 | CA | MD | Home Modifications Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207612800000",
"number": "1699948083",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "90 LAKESHORE DR.",
"city": "RANCHO MIRAGE",
"state": "CA",
"postal_code": "92270",
"telephone_number": "760-469-3208"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 LAKE SHORE DR",
"city": "RANCHO MIRAGE",
"state": "CA",
"postal_code": "922704054",
"telephone_number": "760-469-3208"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JONES",
"first_name": "JACK",
"middle_name": "EDWARD",
"name_prefix": "Mr.",
"name_suffix": "II",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-08",
"last_updated": "2008-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "171WH0202X",
"taxonomy_group": "",
"desc": "Contractor, Home Modifications",
"state": "CA",
"license": "482707",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Mirage, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.