Provider Demographics
NPI:1518286699
Name:UPTOWN WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:UPTOWN WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-935-1830
Mailing Address - Street 1:2529 W BUSCH BLVD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4545
Mailing Address - Country:US
Mailing Address - Phone:813-935-1830
Mailing Address - Fax:813-933-3501
Practice Address - Street 1:2529 W BUSCH BLVD
Practice Address - Street 2:SUITE 1000
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4545
Practice Address - Country:US
Practice Address - Phone:813-935-1830
Practice Address - Fax:813-933-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8261261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center