Provider Demographics
NPI:1306038625
Name:WILLIAM P JORDAN MD FACS
Entity Type:Organization
Organization Name:WILLIAM P JORDAN MD FACS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-421-8948
Mailing Address - Street 1:175 EAST BROWN STREET
Mailing Address - Street 2:SUITE 107 BUILDING 1
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301
Mailing Address - Country:US
Mailing Address - Phone:570-421-8948
Mailing Address - Fax:570-424-7370
Practice Address - Street 1:175 EAST BROWN STREET SUITE 107 BUILDING 1
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301
Practice Address - Country:US
Practice Address - Phone:570-421-8948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030238L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
073897OtherFIRST PRIORITY
P1262402OtherOXFORD
6000863OtherGHI
PA73907OtherUNISON
PA0006431270001Medicaid
2Y9564OtherHEALTHNET
076889OtherBCBS
10929414OtherUNITED HEALTHCARE
1626362OtherBCBS
P018087OtherCHAMPUS
PA0061042OtherETNA
P018087OtherCHAMPUS
076889OtherBCBS
=========OtherEIN AND TRICARE
PA0061042OtherETNA