Provider Demographics
NPI:1871259879
Name:JT HEALTH LLC
Entity type:Organization
Organization Name:JT HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRIMARY PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:REGGIO
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:580-789-1628
Mailing Address - Street 1:1605 COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:BLACKWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74631-6749
Mailing Address - Country:US
Mailing Address - Phone:580-716-0245
Mailing Address - Fax:
Practice Address - Street 1:105 E. GRAND
Practice Address - Street 2:
Practice Address - City:TONKAWA
Practice Address - State:OK
Practice Address - Zip Code:74653-3503
Practice Address - Country:US
Practice Address - Phone:580-789-1628
Practice Address - Fax:888-712-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-13
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK187125879OtherFACILITY NPI