MEDICARE: JORDAN PHYSICIAN ASSOCIATES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	207RH0003X	Hematology & Oncology Physician
3	363LA2200X	Adult Health Nurse Practitioner
4	363LF0000X	Family Nurse Practitioner
5	207V00000X	Obstetrics & Gynecology Physician
6	2085R0202X	Diagnostic Radiology Physician
7	2085U0001X	Diagnostic Ultrasound Physician
8	208600000X	Surgery Physician
9	2086S0129X	Vascular Surgery Physician
10	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	M15987	OTHER	MA	BCBSMA
3	AA229234	OTHER	MA	HARVARD PILGRIM HEALTHCARE
4	602198	OTHER	MA	TUFTS HEALTH PLAN

General Provider Information

NPI Number	:	1538145131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JORDAN PHYSICIAN ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	36 CORDAGE PARK CIR
Second Line	:	SUITE 317
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-7331
Country	:	US
Telephone Number	:	508-830-2428
Fax Number	:	508-830-2502

Provider Business Practice Location Address
First Line	:	275 SANDWICH ST
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-2183
Country	:	US
Telephone Number	:	508-830-2401
Fax Number	:	508-830-1131

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KEVIN COUGHLIN
Credential	:
Telephone Number	:	508-746-2000

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	12/15/2021

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Directions to “JORDAN PHYSICIAN ASSOCIATES, INC. ” Practice Location

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