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General NPI Number Information
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NPI Number | 1245419431
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Entity Type | Organization
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Legal Business Name | JORDAN'S PLACE PEDIATRICS, PA
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 1317 N HILLCREST DR
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City | SULPHUR SPRINGS
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State | TX
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Zip | 75482-2091
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Country | US
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Telephone | 903-438-1110
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Fax | 903-438-1107
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Provider Business Mailing Address
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Address Line | 1317 N HILLCREST DR
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City | SULPHUR SPRINGS
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State | TX
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Zip | 75482-2091
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Country | US
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Telephone | 903-438-1110
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Fax | 903-438-1107
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Authorized Official
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Title or Position | PHYSICAN
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Name | DR. SHERRI STONE BARCLAY
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Credential | M.D.
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Telephone | 903-438-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | K7145
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License Number State | TX
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