Healthcare Provider Details

I. General information

NPI: 1619897733
Provider Name (Legal Business Name): JORDAN JAMES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 LINDELL BLVD
SAINT LOUIS MO
63108-3701
US

IV. Provider business mailing address

4625 LINDELL BLVD
SAINT LOUIS MO
63108-3701
US

V. Phone/Fax

Practice location:
  • Phone: 314-412-7342
  • Fax:
Mailing address:
  • Phone: 314-412-7342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: