1306038625 NPI number — WILLIAM P JORDAN MD FACS

Table of content: (NPI 1306038625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306038625 NPI number — WILLIAM P JORDAN MD FACS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM P JORDAN MD FACS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306038625
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 EAST BROWN STREET
Provider Second Line Business Mailing Address:
SUITE 107 BUILDING 1
Provider Business Mailing Address City Name:
EAST STROUDSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-421-8948
Provider Business Mailing Address Fax Number:
570-424-7370

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 EAST BROWN STREET SUITE 107 BUILDING 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-421-8948
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JORDAN
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
PETER
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
570-421-8948

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD030238L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 073897 . This is a "FIRST PRIORITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: P1262402 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6000863 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 73907 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0006431270001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2Y9564 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 076889 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10929414 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1626362 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P018087 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0061042 . This is a "ETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".