Provider Demographics
NPI:1689446189
Name:JASPER HEALTH WORX LLC
Entity Type:Organization
Organization Name:JASPER HEALTH WORX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMPERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-482-1041
Mailing Address - Street 1:300B INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65793-9573
Mailing Address - Country:US
Mailing Address - Phone:877-291-6488
Mailing Address - Fax:812-480-0280
Practice Address - Street 1:300B INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:65793-9573
Practice Address - Country:US
Practice Address - Phone:877-291-6488
Practice Address - Fax:812-480-0280
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JASPER HEALTH WORX LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty