MR. GLEN S. JORDAN PA-C NPI 1790885341

NPI Information

NPI: 1790885341
Provider Name: MR. GLEN S. JORDAN, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

PECOS Registration: Yes

Address:
1340 HAL GREER BLVD
HUNTINGTON, WV
ZIP 25701
Phone: (304) 399-6727
Get Directions

MR. Glen S. Jordan, PA-C is a medical physician assistant in Huntington, WV. MR. Glen S. Jordan, PA-C NPI is 1790885341. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1340 HAL GREER BLVD
HUNTINGTON, WV
ZIP 25701-804
Phone: (304) 399-6727
Fax: (304) 399-6726

The NPI 1790885341 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/24/2006 and was last updated on 4/13/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	01222	WEST VIRGINIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	7100118540	MEDICAID	KENTUCKY
2	P00711764	OTHER	WEST VIRGINIA	MEDICARE RR
3	1790885341	MEDICAID	WEST VIRGINIA
4	0080124	MEDICAID	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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