Provider Demographics
NPI:1902915135
Name:JORDAN, LOUIS COLLIER (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:COLLIER
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W STONE DR
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3365
Mailing Address - Country:US
Mailing Address - Phone:423-408-7220
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:2428 KNOB CREEK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2397
Practice Address - Country:US
Practice Address - Phone:423-282-5054
Practice Address - Fax:423-283-0516
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11556207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA320315OtherANTHEM
TN4017303OtherBCBS
NC89014ATMedicaid
NC890564PMedicaid
TN3373123Medicaid
VA005867975Medicaid
TNTN0103OtherJDH
TNTN0103OtherJDH
B59480Medicare UPIN
TN3373123Medicare ID - Type UnspecifiedGROUP #
TN3373123Medicaid
GA060066346Medicare ID - Type UnspecifiedRAILROAD MEDICARE