Provider Demographics
NPI:1972231041
Name:JWGLLC
Entity Type:Organization
Organization Name:JWGLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:580-980-0945
Mailing Address - Street 1:3915 SMISER RD
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:OK
Mailing Address - Zip Code:74730-3854
Mailing Address - Country:US
Mailing Address - Phone:580-980-0945
Mailing Address - Fax:580-434-6513
Practice Address - Street 1:712 NORTH MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:CALERA
Practice Address - State:OK
Practice Address - Zip Code:74730
Practice Address - Country:US
Practice Address - Phone:580-434-6512
Practice Address - Fax:580-434-6513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health