MEDICARE: JORDAN MEDICAL BILLING, LLC

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
1	174400000X	Specialist	5387842	FL

General Provider Information

NPI Number	:	1952706939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JORDAN MEDICAL BILLING, LLC

Provider Business Mailing Address
First Line	:	3255 NW 94TH AVE
Second Line	:	9586
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33075-2001
Country	:	US
Telephone Number	:	888-240-5205
Fax Number	:

Provider Business Practice Location Address
First Line	:	3255 NW 94TH AVE
Second Line	:	9586
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33075-2001
Country	:	US
Telephone Number	:	888-240-5205
Fax Number	:

Authorized Official
Title or Position	:	BILLING AGENT/OWNER
Name	:	MISS TAMICA JORDAN
Credential	:
Telephone Number	:	888-240-5205

Provider Enumeration Date	:	11/03/2014
Last Update Date	:	11/03/2014

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