Provider Demographics
NPI:1689247645
Name:MEDWELLNESS CONSULTING LLC
Entity Type:Organization
Organization Name:MEDWELLNESS CONSULTING LLC
Other - Org Name:SOUTHERN OREGON WEIGHT HEALTHY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EE
Authorized Official - Middle Name:LIN
Authorized Official - Last Name:WAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-690-8231
Mailing Address - Street 1:749 GOLF VIEW DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9654
Mailing Address - Country:US
Mailing Address - Phone:541-690-8231
Mailing Address - Fax:918-233-2265
Practice Address - Street 1:749 GOLF VIEW DR UNIT A
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9654
Practice Address - Country:US
Practice Address - Phone:541-690-8231
Practice Address - Fax:918-233-2265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty