Provider Demographics
NPI:1437487352
Name:NORTHWEST WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:NORTHWEST WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:C
Authorized Official - Last Name:POPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-977-9077
Mailing Address - Street 1:2960 N STATE ROAD 7
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5755
Mailing Address - Country:US
Mailing Address - Phone:954-977-9077
Mailing Address - Fax:954-979-0675
Practice Address - Street 1:2960 N STATE ROAD 7
Practice Address - Street 2:SUITE 204
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5755
Practice Address - Country:US
Practice Address - Phone:954-977-9077
Practice Address - Fax:954-979-0675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-04
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-78747207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3189Medicare UPIN
FLE3189Medicare PIN