Provider Demographics
NPI:1386960417
Name:JW MEDICAL, INC.
Entity type:Organization
Organization Name:JW MEDICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:JACQUOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-357-6673
Mailing Address - Street 1:525 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:IL
Mailing Address - Zip Code:62321-1338
Mailing Address - Country:US
Mailing Address - Phone:217-357-6673
Mailing Address - Fax:217-357-3060
Practice Address - Street 1:501 E GRANT ST
Practice Address - Street 2:SUITE #4
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3374
Practice Address - Country:US
Practice Address - Phone:309-837-6673
Practice Address - Fax:877-275-1829
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JW MEDICAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-14
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL=========002Medicaid