Provider Demographics
NPI:1295886448
Name:KATHY Y JONES MD LLC
Entity type:Organization
Organization Name:KATHY Y JONES MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-228-8066
Mailing Address - Street 1:PO BOX 470308
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-0308
Mailing Address - Country:US
Mailing Address - Phone:407-228-8066
Mailing Address - Fax:407-228-8438
Practice Address - Street 1:2501 N ORANGE AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4603
Practice Address - Country:US
Practice Address - Phone:407-228-8066
Practice Address - Fax:407-228-8438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259275400Medicaid
FL259275400Medicaid