Provider Demographics
NPI:1487896957
Name:JWTDO LLC
Entity type:Organization
Organization Name:JWTDO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-581-9700
Mailing Address - Street 1:P.O. BOX 266
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:MO
Mailing Address - Zip Code:65254
Mailing Address - Country:US
Mailing Address - Phone:573-581-9700
Mailing Address - Fax:573-581-9701
Practice Address - Street 1:911 8TH ST.
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:MO
Practice Address - Zip Code:65254
Practice Address - Country:US
Practice Address - Phone:573-581-9700
Practice Address - Fax:573-581-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6443170002Medicare NSC