Provider Demographics
NPI:1497014542
Name:WARRENSBURG WELLNESS LLC
Entity Type:Organization
Organization Name:WARRENSBURG WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ALEX
Authorized Official - Last Name:BEDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:660-429-5533
Mailing Address - Street 1:638 E YOUNG AVE
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-9608
Mailing Address - Country:US
Mailing Address - Phone:660-429-5533
Mailing Address - Fax:660-429-5554
Practice Address - Street 1:638 E YOUNG AVE
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-9608
Practice Address - Country:US
Practice Address - Phone:660-429-5533
Practice Address - Fax:660-429-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002024548261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty