Provider Demographics
NPI:1821413311
Name:PHYSICIAN WELLNESS, LLC
Entity Type:Organization
Organization Name:PHYSICIAN WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KONRAD
Authorized Official - Middle Name:H
Authorized Official - Last Name:KAEDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-593-5904
Mailing Address - Street 1:825 DAVIS ST
Mailing Address - Street 2:E
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7009
Mailing Address - Country:US
Mailing Address - Phone:540-953-3300
Mailing Address - Fax:
Practice Address - Street 1:825 DAVIS ST
Practice Address - Street 2:E
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7009
Practice Address - Country:US
Practice Address - Phone:540-953-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059231207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty