MEDICARE: JORDAN MEDICAL, 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	332BC3200X	Customized Equipment (DME)
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
3	332BX2000X	Oxygen Equipment & Supplies (DME)
4	332B00000X	Durable Medical Equipment & Medical Supplies	MG0462	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134164759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JORDAN MEDICAL, LLC

Provider Business Mailing Address
First Line	:	PO BOX 346
Second Line	:
City	:	BEATTYVILLE
State	:	KY
Zip	:	41311-0346
Country	:	US
Telephone Number	:	606-464-9100
Fax Number	:	606-464-9191

Provider Business Practice Location Address
First Line	:	1075 HIGHWAY 11 NORTH
Second Line	:
City	:	BEATTYVILLE
State	:	KY
Zip	:	41311-8719
Country	:	US
Telephone Number	:	606-464-9100
Fax Number	:	606-464-9191

Authorized Official
Title or Position	:	MEMBER
Name	:	ROSEMARY C SMITH
Credential	:	R. PH.
Telephone Number	:	606-464-3901

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	06/18/2012

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Directions to “JORDAN MEDICAL, LLC ” Practice Location

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