MEDICARE: JADAM LAWTON LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1053768028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JADAM LAWTON LLC

Provider Business Mailing Address
First Line	:	1354 NW HOMESTEAD DR
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-5223
Country	:	US
Telephone Number	:	580-699-5455
Fax Number	:	580-215-4991

Provider Business Practice Location Address
First Line	:	1354 NW HOMESTEAD DR
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-5223
Country	:	US
Telephone Number	:	580-699-5455
Fax Number	:	580-215-4991

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JENNIFER RODRICK
Credential	:
Telephone Number	:	580-699-5455

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	10/14/2020

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