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NPI Code Detail

MEDICARE: JORDAN'S PLACE PEDIATRICS, PA

MEDICARE: JORDAN'S PLACE PEDIATRICS, PA
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
1261QP2300XPrimary Care Clinic/CenterK7145TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18C0310OTHERTXBCBS INDVL
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
30069GWOTHERTXBCBS GROUP
41154381259OTHERTXNPI INDVL
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245419431
Entity Type Code : Organization
Provider Name (Legal Business Name) : JORDAN'S PLACE PEDIATRICS, PA
Provider Business Mailing Address
First Line : 1317 N HILLCREST DR
Second Line :
City : SULPHUR SPRINGS
State : TX
Zip : 75482-2091
Country : US
Telephone Number : 903-438-1110
Fax Number : 903-438-1107
Provider Business Practice Location Address
First Line : 1317 N HILLCREST DR
Second Line :
City : SULPHUR SPRINGS
State : TX
Zip : 75482-2091
Country : US
Telephone Number : 903-438-1110
Fax Number : 903-438-1107
Authorized Official
Title or Position : PHYSICAN
Name : DR. SHERRI STONE BARCLAY
Credential : M.D.
Telephone Number : 903-438-1110
Provider Enumeration Date : 10/24/2007
Last Update Date : 10/24/2007

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Directions to “JORDAN'S PLACE PEDIATRICS, PA ” Practice Location

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