Provider Demographics
NPI:1407923261
Name:JODON ORTHOPEDICS LLC
Entity Type:Organization
Organization Name:JODON ORTHOPEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:CORDOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-632-2551
Mailing Address - Street 1:1012 W 36TH ST
Mailing Address - Street 2:SUITE #5
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NC
Mailing Address - Zip Code:69361-5007
Mailing Address - Country:US
Mailing Address - Phone:308-632-2551
Mailing Address - Fax:308-632-2725
Practice Address - Street 1:1012 W 36TH ST
Practice Address - Street 2:SUITE #5
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NC
Practice Address - Zip Code:69361-5007
Practice Address - Country:US
Practice Address - Phone:308-632-2551
Practice Address - Fax:308-632-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09009OtherBCBS
NEF952OtherMIDLANDS CHOICE
NEF952OtherMIDLANDS CHOICE
NE09009OtherBCBS