Provider Demographics
NPI:1326693474
Name:WELLNESS CENTERS OF MIDAMERICA PLLC
Entity Type:Organization
Organization Name:WELLNESS CENTERS OF MIDAMERICA PLLC
Other - Org Name:ARKANSAS PAIN, WOUND AND WELNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER MD
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-567-5467
Mailing Address - Street 1:2621 W MAIN ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2551
Mailing Address - Country:US
Mailing Address - Phone:479-567-5467
Mailing Address - Fax:479-219-5500
Practice Address - Street 1:2621 W MAIN ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2551
Practice Address - Country:US
Practice Address - Phone:479-567-5467
Practice Address - Fax:479-219-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty