MEDICARE: DR. JORDAN CARDIOLOGY CENTER

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	207RC0000X	Cardiovascular Disease Physician	13273	PR

General Provider Information

NPI Number	:	1649306085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JORDAN CARDIOLOGY CENTER

Provider Business Mailing Address
First Line	:	PO BOX 11689
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00910-2789
Country	:	US
Telephone Number	:	787-728-7083
Fax Number	:	787-728-3366

Provider Business Practice Location Address
First Line	:	1814 AVE FERNANDEZ JUNCOS
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00909-3001
Country	:	US
Telephone Number	:	787-728-7083
Fax Number	:	787-728-3366

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDMUNDO J JORDAN-MOREY
Credential	:	MD
Telephone Number	:	787-728-7083

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/09/2008

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