Provider Demographics
NPI:1619283454
Name:JW MEDICAL, L.L.C.
Entity Type:Organization
Organization Name:JW MEDICAL, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:FNP
Authorized Official - Phone:502-386-9390
Mailing Address - Street 1:889 CLARKS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-2437
Mailing Address - Country:US
Mailing Address - Phone:502-386-9390
Mailing Address - Fax:
Practice Address - Street 1:889 CLARKS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-2437
Practice Address - Country:US
Practice Address - Phone:502-386-9390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6597363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty