| Jwgllc | |
|
712 North Mckinley Ave Calera OK 74730 | |
| (580) 434-6512 | |
| (580) 434-6513 |
| Full Name | Jwgllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 712 North Mckinley Ave, Calera, Oklahoma |
| Authorized Official Name and Position | Emily Ruth Love (NURSE PRACTITIONER/OWNER) |
| Authorized Official Contact | 5809800945 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jwgllc 3915 Smiser Rd Calera OK 74730-3854 Ph: (580) 980-0945 | Jwgllc 712 North Mckinley Ave Calera OK 74730 Ph: (580) 434-6512 |
| NPI Number | 1972231041 |
|---|---|
| Provider Enumeration Date | 08/08/2022 |
| Last Update Date | 08/08/2022 |
| Medicare PECOS PAC ID | 5991171779 |
|---|---|
| Medicare Enrollment ID | O20221019001533 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972231041 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
| Provider Name | Emily Love |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760721294 PECOS PAC ID: 5294954814 Enrollment ID: I20140915000437 |
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