Provider Demographics
NPI:1053768028
Name:JADAM LAWTON LLC
Entity type:Organization
Organization Name:JADAM LAWTON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-699-5455
Mailing Address - Street 1:1354 NW HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5223
Mailing Address - Country:US
Mailing Address - Phone:580-699-5455
Mailing Address - Fax:580-215-4991
Practice Address - Street 1:1354 NW HOMESTEAD DR
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5223
Practice Address - Country:US
Practice Address - Phone:580-699-5455
Practice Address - Fax:580-215-4991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty