Provider Demographics
NPI:1609297902
Name:WELLNESS MED CLINICS LLC
Entity Type:Organization
Organization Name:WELLNESS MED CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-301-1166
Mailing Address - Street 1:5510 S IH 35 STE 250A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3344
Mailing Address - Country:US
Mailing Address - Phone:512-301-1166
Mailing Address - Fax:
Practice Address - Street 1:5510 S IH 35 STE 250A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3344
Practice Address - Country:US
Practice Address - Phone:512-301-1166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3680207Q00000X
TXPA03274363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty