Provider Demographics
NPI:1003536871
Name:PIVOTAL HEALTH & WELLNESS INC
Entity Type:Organization
Organization Name:PIVOTAL HEALTH & WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-955-0670
Mailing Address - Street 1:314 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COURTLAND
Mailing Address - State:KS
Mailing Address - Zip Code:66939-3024
Mailing Address - Country:US
Mailing Address - Phone:785-955-0670
Mailing Address - Fax:
Practice Address - Street 1:314 MAIN ST
Practice Address - Street 2:
Practice Address - City:COURTLAND
Practice Address - State:KS
Practice Address - Zip Code:66939-3024
Practice Address - Country:US
Practice Address - Phone:785-955-0670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSA-079-005Medicaid