Provider Demographics
NPI:1245419431
Name:JORDAN'S PLACE PEDIATRICS, PA
Entity Type:Organization
Organization Name:JORDAN'S PLACE PEDIATRICS, PA
Other - Org Name:JORDAN'S PLACE PEDIATRICS, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:STONE
Authorized Official - Last Name:BARCLAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-438-1110
Mailing Address - Street 1:1317 N HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-2091
Mailing Address - Country:US
Mailing Address - Phone:903-438-1110
Mailing Address - Fax:903-438-1107
Practice Address - Street 1:1317 N HILLCREST DR
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2091
Practice Address - Country:US
Practice Address - Phone:903-438-1110
Practice Address - Fax:903-438-1107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7145261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C0310OtherBCBS INDVL
TX150000102Medicaid
TX0069GWOtherBCBS GROUP
TX1154381259OtherNPI INDVL
TX150000101Medicaid