Provider Demographics
NPI:1760928063
Name:PHYSICIANS WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:PHYSICIANS WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:POPA
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:513-266-6226
Mailing Address - Street 1:228 PALM IS NW
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33767-1934
Mailing Address - Country:US
Mailing Address - Phone:513-266-6226
Mailing Address - Fax:513-887-7512
Practice Address - Street 1:228 PALM IS NW
Practice Address - Street 2:
Practice Address - City:CLEARWATER BEACH
Practice Address - State:FL
Practice Address - Zip Code:33767-1934
Practice Address - Country:US
Practice Address - Phone:513-266-6226
Practice Address - Fax:513-887-7512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty