MEDICARE: JW PORTER CONSULTANTS 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1336692284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JW PORTER CONSULTANTS LLC

Provider Business Mailing Address
First Line	:	6272 LAKE OSPREY DR
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34240-8425
Country	:	US
Telephone Number	:	941-666-8757
Fax Number	:

Provider Business Practice Location Address
First Line	:	6272 LAKE OSPREY DR
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34240-8425
Country	:	US
Telephone Number	:	941-666-8757
Fax Number	:	941-348-1421

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	KINGA PORTER
Credential	:	D.O
Telephone Number	:	941-666-8757

Provider Enumeration Date	:	07/27/2016
Last Update Date	:	02/22/2022

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