Provider Demographics
NPI:1609242619
Name:THE HEALTH & WELLNESS CENTER FOR MEN, LLC
Entity Type:Organization
Organization Name:THE HEALTH & WELLNESS CENTER FOR MEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SECIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHODROSKI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:314-722-6555
Mailing Address - Street 1:9717 LANDMARK PARKWAY DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1628
Mailing Address - Country:US
Mailing Address - Phone:314-722-6555
Mailing Address - Fax:314-722-6551
Practice Address - Street 1:9717 LANDMARK PARKWAY DR
Practice Address - Street 2:SUITE 115
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1628
Practice Address - Country:US
Practice Address - Phone:314-722-6555
Practice Address - Fax:314-722-6551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014014296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty