Provider Demographics
NPI:1033587720
Name:EL DORADO WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:EL DORADO WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGRETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-864-9962
Mailing Address - Street 1:431 THOMPSON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4553
Mailing Address - Country:US
Mailing Address - Phone:870-864-9962
Mailing Address - Fax:
Practice Address - Street 1:431 THOMPSON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4553
Practice Address - Country:US
Practice Address - Phone:870-864-9962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty