Provider Demographics
NPI:1356830251
Name:METAIRIE TOTAL WELLNESS CLINIC, LLC
Entity Type:Organization
Organization Name:METAIRIE TOTAL WELLNESS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-714-5343
Mailing Address - Street 1:5000 ELDORADO PKWY STE 150-153
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-8695
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1813 VETERANS MEMORIAL BLVD STE B
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-2637
Practice Address - Country:US
Practice Address - Phone:800-246-5698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MODERN MALE T-CLINIC, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty