Individual ProviderJordan Bistafa LiuStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address3333 Glendale Ave, Toledo, OH 43614-2426(419) 383-5555PECOS EnrollmentBased on the most recent information from CMS, provider Jordan Bistafa Liu is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records today at 11:36 AM.Profile DetailsProvider ID1841041720Provider TypeIndividualFull NameBistafa Liu, JordanCredentialMDGenderMaleSole ProprietorYesEnumeration Date3/29/2024Last Updated3/29/2024Contact InformationPractice LocationPractice Address3333 Glendale Ave, Toledo, OH 43614-2426Phone(419) 383-5555Fax(419) 383-3113Mailing LocationMailing Address3333 Glendale Ave, Toledo, OH 43614-2426PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer