Provider Demographics
NPI:1326350158
Name:JT DEWITT, D.O., P.A.
Entity Type:Organization
Organization Name:JT DEWITT, D.O., P.A.
Other - Org Name:DEWITT FAMILY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-897-8438
Mailing Address - Street 1:11998 HIGHWAY 49 N
Mailing Address - Street 2:
Mailing Address - City:MARMADUKE
Mailing Address - State:AR
Mailing Address - Zip Code:72443-9597
Mailing Address - Country:US
Mailing Address - Phone:870-597-1231
Mailing Address - Fax:
Practice Address - Street 1:11998 HIGHWAY 49 N
Practice Address - Street 2:
Practice Address - City:MARMADUKE
Practice Address - State:AR
Practice Address - Zip Code:72443-9597
Practice Address - Country:US
Practice Address - Phone:870-597-1231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care