Provider Demographics
NPI:1407541113
Name:KWUS HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:KWUS HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:KIMBER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:205-997-0175
Mailing Address - Street 1:PO BOX 3650
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-0650
Mailing Address - Country:US
Mailing Address - Phone:205-997-0175
Mailing Address - Fax:
Practice Address - Street 1:146 RIVER SQUARE PLZ
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-1667
Practice Address - Country:US
Practice Address - Phone:205-997-0175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty