MEDICARE: JORDAN SOUTHERN

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	208800000X	Urology Physician	MD471223	PA

General Provider Information

NPI Number	:	1730575879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN SOUTHERN

Provider Business Mailing Address
First Line	:	601 MEMORY LN
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-2231
Country	:	US
Telephone Number	:	717-851-1405
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 HOSPITAL DR
Second Line	:
City	:	LEWISBURG
State	:	PA
Zip	:	17837-9362
Country	:	US
Telephone Number	:	570-523-3900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2015
Last Update Date	:	06/19/2026

Similar Medicare Providers

1336120096 — MRS. BONNIE LYNN GALLOWAY CNM
Practice Location Address:

3 HOSPITAL DR , SUITE 312
LEWISBURG, PA
17837-9362

Practice Phone: 570-523-8700
Practice Fax: 570-523-8705

1558347518 — DARSHAN KUMAR BHANGDIA MD
Practice Location Address:

3 HOSPITAL DR , SUITE 306
LEWISBURG, PA
17837-9362

Practice Phone: 570-523-3900
Practice Fax: 570-523-3834

1245216001 — DAVID CLINTON WEIBEL MD
Practice Location Address:

3 HOSPITAL DR , SUITE 306
LEWISBURG, PA
17837-9362

Practice Phone: 570-523-3900
Practice Fax: 570-523-3834

1699753699 — SUSAN BARE CNM
Practice Location Address:

3 HOSPITAL DR , SUITE 312
LEWISBURG, PA
17837-9362

Practice Phone: 570-523-8700
Practice Fax: 570-523-8705

1275512816 — MARY HEGARTY CRNP
Practice Location Address:

3 HOSPITAL DR , SUITE 312
LEWISBURG, PA
17837-9362

Practice Phone: 570-523-8700
Practice Fax: 570-513-8705

1679552160 — LYNN HUNTER CRNP
Practice Location Address:

3 HOSPITAL DR , SUITE 312
LEWISBURG, PA
17837-9362

Practice Phone: 570-523-8700
Practice Fax: 570-523-8705

Directions to “ JORDAN SOUTHERN ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.