Organization Name: | MEDICAL WELLNESS LLC |
NPI Number: | 1386023828 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STEVEN PAUL JESKE (OWNER) |
Mailing Address: | 503 Wolcott Rd #3 Wolcott |
State: | CT US |
Postal Code: | 067162673 |
Phone Number: | 2039481300 |
Fax Number: | 8883726480 |
NPI Enumeration Date: | 05/28/2015 |
NPI Last Update Date: | 05/28/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 12.004592 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |