Provider Demographics
NPI:1366033656
Name:KATHLEEN JORDAN MD PC
Entity Type:Organization
Organization Name:KATHLEEN JORDAN MD PC
Other - Org Name:
Other - Org Type:
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:973-943-0967
Mailing Address - Fax:
Practice Address - Street 1:15051 N KIERLAND BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-8161
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:2021-01-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty