Provider Demographics
NPI:1114495785
Name:RELIANT HEALTH & WELLNESS PLLC
Entity Type:Organization
Organization Name:RELIANT HEALTH & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BUSHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-599-0272
Mailing Address - Street 1:822 W RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-3834
Mailing Address - Country:US
Mailing Address - Phone:580-599-0272
Mailing Address - Fax:580-603-8602
Practice Address - Street 1:822 W RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-3834
Practice Address - Country:US
Practice Address - Phone:580-599-0272
Practice Address - Fax:580-603-8602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-12
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty