Provider Demographics
NPI:1326078064
Name:TRANSFORMATION WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:TRANSFORMATION WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:M
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO, PHARMD,MPH
Authorized Official - Phone:270-443-0885
Mailing Address - Street 1:632 LONE OAK RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-4540
Mailing Address - Country:US
Mailing Address - Phone:270-443-0885
Mailing Address - Fax:270-443-9068
Practice Address - Street 1:632 LONE OAK RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-4540
Practice Address - Country:US
Practice Address - Phone:270-443-0885
Practice Address - Fax:270-443-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02797207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty