Provider Demographics
NPI:1235651381
Name:THE WELLNESS PLAN MEDICAL CENTERS
Entity Type:Organization
Organization Name:THE WELLNESS PLAN MEDICAL CENTERS
Other - Org Name:THE WELLNESS PLAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO & EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:V
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-202-8550
Mailing Address - Street 1:7700 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2477
Mailing Address - Country:US
Mailing Address - Phone:313-202-8660
Mailing Address - Fax:313-202-8653
Practice Address - Street 1:46156 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-5033
Practice Address - Country:US
Practice Address - Phone:248-897-0900
Practice Address - Fax:248-858-6499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGOtherPER WPS
1235651381OtherPER WPS