Healthcare Provider Details

I. General information

NPI: 1710403795
Provider Name (Legal Business Name): JASPER HEALTH WORX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 WERNSING RD
JASPER IN
47546-8141
US

IV. Provider business mailing address

PO BOX 390
JASPER IN
47547-0390
US

V. Phone/Fax

Practice location:
  • Phone: 877-291-6488
  • Fax:
Mailing address:
  • Phone: 877-291-6488
  • Fax: 812-481-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number71003375A
License Number StateIN

VIII. Authorized Official

Name: MRS. LINDA LOU GOEPPNER
Title or Position: MANAGER
Credential: PHR
Phone: 812-482-1041