Provider Demographics
NPI:1427542422
Name:MEDWELL GROUP INTERNATIONAL LLC
Entity Type:Organization
Organization Name:MEDWELL GROUP INTERNATIONAL LLC
Other - Org Name:MEDWELL FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAJOR
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAUSING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-780-0759
Mailing Address - Street 1:2925 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-6459
Mailing Address - Country:US
Mailing Address - Phone:407-780-0759
Mailing Address - Fax:888-344-9692
Practice Address - Street 1:2925 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-6459
Practice Address - Country:US
Practice Address - Phone:407-780-0759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2019-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty