Provider Demographics
NPI:1003069279
Name:CLINIC FOR FAMILY WELLNESS PLLC
Entity Type:Organization
Organization Name:CLINIC FOR FAMILY WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:806-259-1058
Mailing Address - Street 1:1645 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TX
Mailing Address - Zip Code:79245-2059
Mailing Address - Country:US
Mailing Address - Phone:806-259-1058
Mailing Address - Fax:806-259-1060
Practice Address - Street 1:1645 N 18TH ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TX
Practice Address - Zip Code:79245-2059
Practice Address - Country:US
Practice Address - Phone:806-259-1058
Practice Address - Fax:806-259-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231272261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center