# JESSE WILLARD WOODS III

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- **Entity:** Organization
- **Status:** Active
- **Other names:** JWWIII Medical Brokerage Services
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265093579
- **Authorized official:** TIGER D. RAVEN-MELCHIZ EL (BUSINESS MANAGER)
- **Authorized official phone:** (215) 435-4203

## Contact information

- **Practice address:** 1410 N 31ST ST, PHILADELPHIA, PA 19121-3870
- **Practice address phone:** (215) 258-4815
- **Mailing address:** 1410 N 31ST ST, PHILADELPHIA, PA 19121-3870
- **Mailing address phone:** (215) 258-4815

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | Yes |
| 171M00000X | Case Manager/Care Coordinator | — | — | Yes |
| 174H00000X | Health Educator | — | NULL | — |
| 174H00000X | Health Educator | — | — | — |
| 207K00000X | Allergy & Immunology Physician | — | NULL | — |
| 207K00000X | Allergy & Immunology Physician | — | — | — |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | — | NULL | — |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | — | — | — |
| 251C00000X | Developmentally Disabled Services Day Training Agency | — | NULL | — |
| 261QC1500X | Community Health Clinic/Center | — | NULL | — |
| 261QH0100X | Health Service Clinic/Center | — | NULL | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 06/26/2019
- **Last updated:** 04/03/2020