Provider Demographics
NPI:1386358422
Name:JT MEDICAL LLC
Entity type:Organization
Organization Name:JT MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:VESTILE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-441-7981
Mailing Address - Street 1:13421 OLD MERIDIAN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1411
Mailing Address - Country:US
Mailing Address - Phone:317-225-5363
Mailing Address - Fax:
Practice Address - Street 1:13421 OLD MERIDIAN ST STE 202
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1411
Practice Address - Country:US
Practice Address - Phone:317-225-5363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty