Cecil Bryan Jordan II
Organization Active NPI Family Medicine Physician · Saint George, SC
NPI 1215110697 · NPPES record last updated Nov 14, 2011
Key facts
- NPI
- 1215110697
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 11810 (SC)
- Legal business name
- CECIL BRYAN JORDAN II
- Practice address
- 109 Dukes St
Saint George, SC 29477-2501 - Phone
- (843) 563-2484
- NPI assigned
- Dec 9, 2007
- Organization subpart
- No
Authorized official
- Name
- Cecil Bryan Jordan II, MD
- Title
- Owner
- Phone
- (843) 563-2484
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120313000947 | SC | Part B Supplier - Clinic/Group Practice | 1355500182 |
Receives reassigned benefits from 1 practitioner Practice locations: Saint George, SC |
National Provider Directory
Locations
109 Dukes St
Saint George, SC 29477
Phone (843) 549-1421
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 11810 | SC | Yes |
Addresses
Primary practice location
109 Dukes St
Saint George, SC 29477-2501
Mailing address
109 Dukes St
Saint George, SC 29477-2501
Phone (843) 563-2484
Other names
- family medicine center
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All providers in Saint George, SC · Family Medicine Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 14, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.