Provider Demographics
NPI:1649306085
Name:DR. JORDAN CARDIOLOGY CENTER
Entity type:Organization
Organization Name:DR. JORDAN CARDIOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMUNDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:JORDAN-MOREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-728-7083
Mailing Address - Street 1:PO BOX 11689
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-2789
Mailing Address - Country:US
Mailing Address - Phone:787-728-7083
Mailing Address - Fax:787-728-3366
Practice Address - Street 1:1814 AVE FERNANDEZ JUNCOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-3001
Practice Address - Country:US
Practice Address - Phone:787-728-7083
Practice Address - Fax:787-728-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13273207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI53500Medicare UPIN
PR24058Medicare PIN
PR0024058Medicare PIN