Provider Demographics
NPI:1578272076
Name:VIP WELLNESS, LLC
Entity Type:Organization
Organization Name:VIP WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRONE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:985-788-7676
Mailing Address - Street 1:10 SAINT ANN DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3265
Mailing Address - Country:US
Mailing Address - Phone:985-788-7676
Mailing Address - Fax:
Practice Address - Street 1:10 SAINT ANN DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3265
Practice Address - Country:US
Practice Address - Phone:985-788-7676
Practice Address - Fax:985-778-2076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty