Provider Demographics
NPI:1750395059
Name:JENNIFER L. JONES, M.D., LLC
Entity type:Organization
Organization Name:JENNIFER L. JONES, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-416-1300
Mailing Address - Street 1:1425 CEDAR WOOD CT
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-2451
Mailing Address - Country:US
Mailing Address - Phone:815-416-0388
Mailing Address - Fax:
Practice Address - Street 1:1499 LAKEWOOD DR
Practice Address - Street 2:UNIT C
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1709
Practice Address - Country:US
Practice Address - Phone:815-416-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH35878Medicare UPIN
IL213796Medicare PIN