Provider Demographics
NPI:1447349584
Name:ANDERSON JONES PODIATRY, LLC
Entity type:Organization
Organization Name:ANDERSON JONES PODIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-352-1473
Mailing Address - Street 1:25 E SCHAUMBURG RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3550
Mailing Address - Country:US
Mailing Address - Phone:847-352-1473
Mailing Address - Fax:847-352-1479
Practice Address - Street 1:25 E SCHAUMBURG RD STE 110
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3548
Practice Address - Country:US
Practice Address - Phone:847-352-1473
Practice Address - Fax:847-352-1479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5812780001Medicare NSC