Provider Demographics
NPI:1518670850
Name:BE WELL MISSISSIPPI LLC
Entity Type:Organization
Organization Name:BE WELL MISSISSIPPI LLC
Other - Org Name:BE WELL MISSISSIPPI, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:662-290-9091
Mailing Address - Street 1:1723 UNIVERSITY AVE SUTE B
Mailing Address - Street 2:BOX 315
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-4725
Mailing Address - Country:US
Mailing Address - Phone:662-290-9091
Mailing Address - Fax:877-550-1363
Practice Address - Street 1:1723 UNIVERSITY AVE STE B
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-4109
Practice Address - Country:US
Practice Address - Phone:662-290-9091
Practice Address - Fax:877-550-1363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Multi-Specialty