Provider Demographics
NPI:1780013722
Name:BIOTEC WELLNESS, LLC
Entity Type:Organization
Organization Name:BIOTEC WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AUTHEMENT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:254-631-3081
Mailing Address - Street 1:2684 COUNTY ROAD 037
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-6456
Mailing Address - Country:US
Mailing Address - Phone:254-631-3081
Mailing Address - Fax:512-233-0514
Practice Address - Street 1:2684 COUNTY ROAD 037
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-6456
Practice Address - Country:US
Practice Address - Phone:254-631-3081
Practice Address - Fax:512-233-0514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory