Provider Demographics
NPI:1609907658
Name:CLASSIC WELLNESS CENTERS
Entity Type:Organization
Organization Name:CLASSIC WELLNESS CENTERS
Other - Org Name:DAVINCI MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAVARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-498-7788
Mailing Address - Street 1:PO BOX 48217
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-0217
Mailing Address - Country:US
Mailing Address - Phone:817-498-7788
Mailing Address - Fax:817-849-1011
Practice Address - Street 1:6709 MEADOW CREST DR
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6669
Practice Address - Country:US
Practice Address - Phone:817-498-7788
Practice Address - Fax:817-849-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty