Provider Demographics
NPI:1225565450
Name:RECONNECT WELLNESS IUKA, LLC
Entity Type:Organization
Organization Name:RECONNECT WELLNESS IUKA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER RECONNECT OUTPATIEN
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-680-3148
Mailing Address - Street 1:PO BOX 3667
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803-3667
Mailing Address - Country:US
Mailing Address - Phone:662-680-3148
Mailing Address - Fax:662-620-9890
Practice Address - Street 1:1670 WHITEHOUSE RD
Practice Address - Street 2:
Practice Address - City:IUKA
Practice Address - State:MS
Practice Address - Zip Code:38852-9013
Practice Address - Country:US
Practice Address - Phone:662-680-3148
Practice Address - Fax:662-620-9890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-18
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization