Organization
JORDAN MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSEMARY C SMITH R. PH. (MEMBER)
(606) 464-3901
Entity
Organization
Contact information
Practice address
1075 HIGHWAY 11 NORTH, BEATTYVILLE, KY 41311-8719
(606) 464-9100
(606) 464-9191
Mailing address
PO BOX 346, BEATTYVILLE, KY 41311-0346
(606) 464-9100
(606) 464-9191
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
MG0462
KY
332BC3200X
Customized Equipment (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
90012139
—
KY
Enumeration date
06/18/2006
Last updated
06/18/2012
Update your record
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