Provider Demographics
NPI:1609347301
Name:WELLNESS MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:WELLNESS MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:ABEGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:CONCON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:702-778-5100
Mailing Address - Street 1:3017 W CHARLESTON BLVD STE 60
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1927
Mailing Address - Country:US
Mailing Address - Phone:702-778-5100
Mailing Address - Fax:702-778-5101
Practice Address - Street 1:3017 W CHARLESTON BLVD STE 60
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1927
Practice Address - Country:US
Practice Address - Phone:702-778-5100
Practice Address - Fax:702-778-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty