Provider Demographics
NPI:1043552458
Name:JWT MEDICAL PLC
Entity type:Organization
Organization Name:JWT MEDICAL PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:TORSETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-443-0236
Mailing Address - Street 1:39733 N LOST LEGEND DR
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3643
Mailing Address - Country:US
Mailing Address - Phone:763-443-0236
Mailing Address - Fax:623-207-4872
Practice Address - Street 1:39733 N LOST LEGEND DR
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3643
Practice Address - Country:US
Practice Address - Phone:763-443-0236
Practice Address - Fax:623-207-4872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-24
Last Update Date:2013-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42825261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty