1477559904 NPI number — CURTIS A JORDAN MD

Table of content: CURTIS A JORDAN MD (NPI 1477559904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477559904 NPI number — CURTIS A JORDAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JORDAN
Provider First Name:
CURTIS
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1477559904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 W 14TH ST
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
JEFFERSONVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47130-3751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-284-0660
Provider Business Mailing Address Fax Number:
812-284-3822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 W 14TH ST
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
JEFFERSONVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47130-3751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-284-0660
Provider Business Practice Location Address Fax Number:
812-284-3822
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  01034505A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 351995025 . This is a "UNITED HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 351995025 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 351995025 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5373086 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 833753 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 351995025 . This is a "SAGAMORE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5373086 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64270846 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1051957 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 918739 . This is a "BLOCK VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000042711 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 019837P . This is a "SIHO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100439320 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33B29 . This is a "IHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64270846 . This is a "UNISYS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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