Provider Demographics
NPI:1760718696
Name:JR WELLNESS SERVICES, LLC
Entity Type:Organization
Organization Name:JR WELLNESS SERVICES, LLC
Other - Org Name:CLINICA LATINA #1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:713-981-6472
Mailing Address - Street 1:6859 S GESSNER DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-4613
Mailing Address - Country:US
Mailing Address - Phone:713-981-6472
Mailing Address - Fax:713-981-6478
Practice Address - Street 1:6859 S GESSNER DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4613
Practice Address - Country:US
Practice Address - Phone:713-981-6472
Practice Address - Fax:713-981-6478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty