Provider Demographics
NPI:1053825364
Name:WELLNESS 1ST INTEGRATIVE MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:WELLNESS 1ST INTEGRATIVE MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FARID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-304-5152
Mailing Address - Street 1:2451 E BASELINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2467
Mailing Address - Country:US
Mailing Address - Phone:480-304-5152
Mailing Address - Fax:480-603-4147
Practice Address - Street 1:2451 E BASELINE RD STE 100
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234
Practice Address - Country:US
Practice Address - Phone:480-304-5152
Practice Address - Fax:480-603-4147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-22
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X, 261QH0100X, 261QP2000X, 261QP3300X, 332BD1200X
AZRN06371261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies