Organization
JESSE WILLARD WOODS III
Active
Other names
JWWIII Medical Brokerage Services
Organization subpart
No
Provider details
NPI number
Authorized official
TIGER D. RAVEN-MELCHIZ EL (BUSINESS MANAGER)
(215) 435-4203
Entity
Organization
Contact information
Practice address
1410 N 31ST ST, PHILADELPHIA, PA 19121-3870
(215) 258-4815
Mailing address
1410 N 31ST ST, PHILADELPHIA, PA 19121-3870
(215) 258-4815
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
174H00000X
Health Educator
—
—
207K00000X
Allergy & Immunology Physician
—
—
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
06/26/2019
Last updated
04/03/2020
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