Healthcare Provider Details

I. General information

NPI: 1366033656
Provider Name (Legal Business Name): KATHLEEN JORDAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15051 N KIERLAND BLVD STE 200
SCOTTSDALE AZ
85254-8161
US

IV. Provider business mailing address

30 E 23RD ST STE 700
NEW YORK NY
10010-4408
US

V. Phone/Fax

Practice location:
  • Phone: 332-203-0933
  • Fax:
Mailing address:
  • Phone: 973-943-0967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TOM BARNES
Title or Position: VP, PAYER STRATEGY & REVENUE CYCLE
Credential:
Phone: 973-943-0967