Provider Demographics
NPI:1467037523
Name:OEG WELLNESS LLC
Entity Type:Organization
Organization Name:OEG WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:BLASCHKE
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:615-979-9453
Mailing Address - Street 1:5400 MARYLAND WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5048
Mailing Address - Country:US
Mailing Address - Phone:615-712-8712
Mailing Address - Fax:615-369-3297
Practice Address - Street 1:5400 MARYLAND WAY STE 100
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5048
Practice Address - Country:US
Practice Address - Phone:615-712-8712
Practice Address - Fax:615-369-3297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center