1952376600 NPI number — LINDA S JOURDAN MD

Table of content: LINDA S JOURDAN MD (NPI 1952376600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952376600 NPI number — LINDA S JOURDAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOURDAN
Provider First Name:
LINDA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1952376600
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6303 HARBRIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46220-4947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-253-2552
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8202 CLEARVISTA PKWY
Provider Second Line Business Practice Location Address:
SUITE 6B
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46256-1442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-621-1670
Provider Business Practice Location Address Fax Number:
317-621-1680
Provider Enumeration Date:
02/17/2006

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: 207Q00000X , with the licence number:  01037882A , 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: 000000606321 . This is a "ANTHEM PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100347360 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4205656 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P01291583 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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