Provider Demographics
NPI:1164672770
Name:JORDAN FAMILY HEALTH, LLC
Entity Type:Organization
Organization Name:JORDAN FAMILY HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-568-5999
Mailing Address - Street 1:8846 S REDWOOD RD
Mailing Address - Street 2:SUITE E-121
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9334
Mailing Address - Country:US
Mailing Address - Phone:801-569-1999
Mailing Address - Fax:801-569-2001
Practice Address - Street 1:8846 S REDWOOD RD
Practice Address - Street 2:SUITE E-121
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9334
Practice Address - Country:US
Practice Address - Phone:801-569-1999
Practice Address - Fax:801-569-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1164672770Medicaid
UT000064950Medicare PIN
UT1164672770Medicaid