Provider Demographics
NPI:1346454410
Name:JORDAN ASHA, PLLC
Entity Type:Organization
Organization Name:JORDAN ASHA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-328-3077
Mailing Address - Street 1:11595 S WILCREST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-4752
Mailing Address - Country:US
Mailing Address - Phone:832-328-3077
Mailing Address - Fax:832-328-3081
Practice Address - Street 1:11595 S WILCREST DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-4752
Practice Address - Country:US
Practice Address - Phone:832-328-3077
Practice Address - Fax:832-328-3081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7248207Q00000X, 207QA0000X, 207QG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163100402Medicaid
TX163100401Medicaid
TX00178WMedicare ID - Type UnspecifiedGROUP NUMBER
TX853618Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE
TX163100402Medicaid