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NPI Code Detail

MEDICARE: DR. SABRINA DANISE JORDAN-CHILDS M.D.

MEDICARE: DR. SABRINA DANISE JORDAN-CHILDS M.D.
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
1207Q00000XFamily Medicine Physician2009018422MO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3107530084OTHERMOWPS MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22009018422OTHERMOMO LICENSEE

General Provider Information

NPI Number : 1649267675
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SABRINA DANISE JORDAN-CHILDS M.D.
Provider Business Mailing Address
First Line : 6121 N HANLEY RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63134-2003
Country : US
Telephone Number : 314-615-0400
Fax Number :
Provider Business Practice Location Address
First Line : 6121 N HANLEY RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63134-2003
Country : US
Telephone Number : 314-615-6909
Fax Number : 314-615-0599
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2005
Last Update Date : 08/02/2019

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