1568653962 NPI number — RHONDA BARNES JORDAN, MD PA

Table of content: (NPI 1568653962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568653962 NPI number — RHONDA BARNES JORDAN, MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RHONDA BARNES JORDAN, MD PA
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:
6
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:
1568653962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2636 S LOOP W
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77054-2680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-834-3800
Provider Business Mailing Address Fax Number:
713-748-4444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2636 S LOOP W
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77054-2680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-834-3800
Provider Business Practice Location Address Fax Number:
713-748-4444
Provider Enumeration Date:
08/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JORDAN
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
BARNES
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
832-834-3800

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  L3571 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200014301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200014302 . This is a "TMHP STEPS TPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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