Provider Demographics
NPI:1013407451
Name:RENOVAR WELLCARE PLLC
Entity Type:Organization
Organization Name:RENOVAR WELLCARE PLLC
Other - Org Name:ESSENCIA FAMILY PRACTICE AND IMMEDIATE CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUSESAN
Authorized Official - Middle Name:OLUSEUN
Authorized Official - Last Name:OLOTU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-306-0016
Mailing Address - Street 1:8533 ROYAL COUNTY DOWN DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-1680
Mailing Address - Country:US
Mailing Address - Phone:972-306-0016
Mailing Address - Fax:
Practice Address - Street 1:1509 W HEBRON PKWY STE 140
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6492
Practice Address - Country:US
Practice Address - Phone:972-306-0016
Practice Address - Fax:972-306-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care