Provider Demographics
NPI:1003538240
Name:COMPLETE WELLNESS FAMILLY MEDICINE, PLLC
Entity Type:Organization
Organization Name:COMPLETE WELLNESS FAMILLY MEDICINE, PLLC
Other - Org Name:COMPLETE WELLNESS FAMILY MEDICINE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-631-8650
Mailing Address - Street 1:2625 REDWING RD STE 260
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6353
Mailing Address - Country:US
Mailing Address - Phone:970-213-0378
Mailing Address - Fax:
Practice Address - Street 1:2627 REDWING RD STE 300
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6310
Practice Address - Country:US
Practice Address - Phone:970-213-0378
Practice Address - Fax:970-672-8137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty