Provider Demographics
NPI:1033720826
Name:WELLNESS & HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:WELLNESS & HEALTH CLINIC LLC
Other - Org Name:WELLNESS & HEALTH CLINIC LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYKUTTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-757-6031
Mailing Address - Street 1:18756 BIENVILLE CT
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3240
Mailing Address - Country:US
Mailing Address - Phone:225-939-3131
Mailing Address - Fax:
Practice Address - Street 1:9241 BLUEBONNET BLVD STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2971
Practice Address - Country:US
Practice Address - Phone:225-757-6031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty