Provider Demographics
NPI:1710403795
Name:JASPER HEALTH WORX LLC
Entity Type:Organization
Organization Name:JASPER HEALTH WORX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:GOEPPNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHR
Authorized Official - Phone:812-482-1041
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47547-0390
Mailing Address - Country:US
Mailing Address - Phone:877-291-6488
Mailing Address - Fax:812-481-0280
Practice Address - Street 1:819 WERNSING RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-8141
Practice Address - Country:US
Practice Address - Phone:877-291-6488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003375A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty