Provider Demographics
NPI:1235787185
Name:INTEGRATED MEDICAL AND WELLNESS CLINIC OF MISSISSIPPI LLC
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL AND WELLNESS CLINIC OF MISSISSIPPI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-248-0561
Mailing Address - Street 1:2556 MARCIA CT
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2352
Mailing Address - Country:US
Mailing Address - Phone:228-248-0561
Mailing Address - Fax:228-248-0562
Practice Address - Street 1:2556 MARCIA CT
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2352
Practice Address - Country:US
Practice Address - Phone:228-248-0561
Practice Address - Fax:228-248-0562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty