MEDICARE: JWSP PLLC

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	207QA0505X	Adult Medicine Physician
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1851687842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JWSP PLLC

Provider Business Mailing Address
First Line	:	617 N THIRD STREET
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76501-3156
Country	:	US
Telephone Number	:	254-935-2660
Fax Number	:	254-935-2660

Provider Business Practice Location Address
First Line	:	617 N 3RD ST
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76501-3156
Country	:	US
Telephone Number	:	254-935-2655
Fax Number	:	254-935-2660

Authorized Official
Title or Position	:	DESIGNATED OFFICIAL
Name	:	JUDY T POSTLE
Credential	:
Telephone Number	:	469-744-0237

Provider Enumeration Date	:	06/28/2011
Last Update Date	:	11/17/2011

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Directions to “JWSP PLLC ” Practice Location

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