Provider Demographics
NPI:1851510663
Name:JORDAN NEUROSERVICES A MEDICAL CORPORATION
Entity type:Organization
Organization Name:JORDAN NEUROSERVICES A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-881-1031
Mailing Address - Street 1:1660 PLUM LN
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4532
Mailing Address - Country:US
Mailing Address - Phone:909-881-1031
Mailing Address - Fax:
Practice Address - Street 1:1660 PLUM LN
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4532
Practice Address - Country:US
Practice Address - Phone:909-881-1031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G283910Medicaid
CAA43717Medicare UPIN
CA00G283910Medicaid