Provider Demographics
NPI:1487689055
Name:JWM MEDICAL INC
Entity Type:Organization
Organization Name:JWM MEDICAL INC
Other - Org Name:ARK VALLEY O&P
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNORP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-609-3030
Mailing Address - Street 1:3223 N WEBB RD
Mailing Address - Street 2:STE 4
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-8175
Mailing Address - Country:US
Mailing Address - Phone:316-609-3030
Mailing Address - Fax:316-609-3080
Practice Address - Street 1:3223 N WEBB RD
Practice Address - Street 2:STE 4
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-8175
Practice Address - Country:US
Practice Address - Phone:316-609-3030
Practice Address - Fax:316-609-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
5615170003Medicare NSC