Provider Demographics
NPI:1053068205
Name:UNIVERSAL TELE-HEALTH & WELLNESS INC
Entity Type:Organization
Organization Name:UNIVERSAL TELE-HEALTH & WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:O
Authorized Official - Last Name:WHITE-CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-282-6441
Mailing Address - Street 1:PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:LAKE HAMILTON
Mailing Address - State:FL
Mailing Address - Zip Code:33851-0482
Mailing Address - Country:US
Mailing Address - Phone:863-282-6441
Mailing Address - Fax:
Practice Address - Street 1:2128 CLERMONT ST
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-8264
Practice Address - Country:US
Practice Address - Phone:863-282-6441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty