Provider Demographics
NPI:1013592393
Name:KATHLEEN JORDAN MD PC
Entity Type:Organization
Organization Name:KATHLEEN JORDAN MD PC
Other - Org Name:TIA MH URL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, PAYER STRATEGY & REVENUE CYCLE
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-943-0967
Mailing Address - Street 1:30 E 23RD ST STE 700
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4408
Mailing Address - Country:US
Mailing Address - Phone:332-203-0933
Mailing Address - Fax:
Practice Address - Street 1:1500 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2513
Practice Address - Country:US
Practice Address - Phone:332-203-0933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KATHLEEN JORDAN MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-17
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty