1316192933 NPI number — CHATHAM RESCUE SQUAD INC

Table of content: DR. JEFFREY WARDE JORDAN MD (NPI 1043248909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316192933 NPI number — CHATHAM RESCUE SQUAD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHATHAM RESCUE SQUAD INC
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:
1316192933
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PADUCAH
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42002-9150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-744-8413
Provider Business Mailing Address Fax Number:
270-744-8642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28 MILITARY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATHAM
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24531-4632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-432-8827
Provider Business Practice Location Address Fax Number:
434-432-3398
Provider Enumeration Date:
11/24/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROBBINS
Authorized Official First Name:
NOAH
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS CAPTAIN
Authorized Official Telephone Number:
434-250-0963

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 709724700 . This is a "DOL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1316192933 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".