Provider Demographics
NPI:1609073964
Name:2234 WELLNESS CLINIC
Entity Type:Organization
Organization Name:2234 WELLNESS CLINIC
Other - Org Name:NONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-208-0000
Mailing Address - Street 1:1110 FM 2234 RD
Mailing Address - Street 2:600
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-6483
Mailing Address - Country:US
Mailing Address - Phone:281-208-0000
Mailing Address - Fax:281-261-5017
Practice Address - Street 1:1110 FM 2234 RD
Practice Address - Street 2:600
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-6483
Practice Address - Country:US
Practice Address - Phone:281-208-0000
Practice Address - Fax:281-261-5017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261Q00000X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service