Provider Demographics
NPI:1750863080
Name:JSW MEDICAL LLC
Entity Type:Organization
Organization Name:JSW MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-782-8481
Mailing Address - Street 1:DEPT # 880246 P.O. BOX 29650
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9650
Mailing Address - Country:US
Mailing Address - Phone:602-782-8481
Mailing Address - Fax:
Practice Address - Street 1:1840 E WARNER RD STE 124
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3445
Practice Address - Country:US
Practice Address - Phone:602-782-8481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies