Provider Demographics
NPI:1063275949
Name:JASPER HEALTH WORX LLC
Entity type:Organization
Organization Name:JASPER HEALTH WORX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMPERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-482-1041
Mailing Address - Street 1:5960 BURLINGAME AVE SW STE A
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-9398
Mailing Address - Country:US
Mailing Address - Phone:877-291-6488
Mailing Address - Fax:
Practice Address - Street 1:5960 BURLINGAME AVE SW STE A
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-9398
Practice Address - Country:US
Practice Address - Phone:877-291-6488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JASPER HEALTH WORX LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty