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General NPI Number Information
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NPI Number | 1073915161
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Entity Type | Individual
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Provider Name | JORDAN TULLIS
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Gender | Male
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 340 N OIL HILL RD
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City | EL DORADO
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State | KS
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Zip | 67042-3352
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Country | US
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Telephone | 316-452-5660
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Fax |
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Provider Business Mailing Address
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Address Line | 520 E AUGUSTA AVE
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City | AUGUSTA
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State | KS
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Zip | 67010
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Country | US
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Telephone | 316-775-5491
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | KS
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