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NPI Code Detail

MEDICARE: JORDAN VANSCOY

MEDICARE: JORDAN VANSCOY
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care CoordinatorWV

General Provider Information

NPI Number : 1689507436
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN VANSCOY
Provider Business Mailing Address
First Line : 301 SCOTT AVE
Second Line :
City : MORGANTOWN
State : WV
Zip : 26508-8804
Country : US
Telephone Number : 304-296-1731
Fax Number :
Provider Business Practice Location Address
First Line : 301 SCOTT AVE
Second Line :
City : MORGANTOWN
State : WV
Zip : 26508-8804
Country : US
Telephone Number : 304-296-1731
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2026
Last Update Date : 06/03/2026

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Directions to “ JORDAN VANSCOY ” Practice Location

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