Basic Information
| Provider Information | |||||||||
| NPI: | 1548642325 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JORDAN | ||||||||
| FirstName: | ARTHUR | ||||||||
| MiddleName: | BUIST | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | V | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3239 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295023239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437777900 | ||||||||
| FaxNumber: | 8437777925 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 E CHEVES ST | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437777900 | ||||||||
| FaxNumber: | 8437777925 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2015 | ||||||||
| LastUpdateDate: | 02/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 38358 | SC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | 38358 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 383588 | 05 | SC | MEDICAID |