Provider Demographics
NPI:1982845012
Name:JMM VENTURES, LLC
Entity Type:Organization
Organization Name:JMM VENTURES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-215-6532
Mailing Address - Street 1:19610 N 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5515
Mailing Address - Country:US
Mailing Address - Phone:623-215-6532
Mailing Address - Fax:
Practice Address - Street 1:19610 N 68TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5515
Practice Address - Country:US
Practice Address - Phone:623-215-6532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30147207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty