Provider Demographics
NPI:1821394685
Name:JW SURGICAL ASSIST
Entity Type:Organization
Organization Name:JW SURGICAL ASSIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPA-C
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-965-8664
Mailing Address - Street 1:1208 GAINES MILLS RD
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-1652
Mailing Address - Country:US
Mailing Address - Phone:972-606-4898
Mailing Address - Fax:
Practice Address - Street 1:1208 GAINES MILLS RD
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-1652
Practice Address - Country:US
Practice Address - Phone:972-606-4898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX186174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty