Provider Demographics
NPI:1891088969
Name:B WELL CLINIC LLC
Entity Type:Organization
Organization Name:B WELL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-245-8582
Mailing Address - Street 1:5031 FOREST DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-7088
Mailing Address - Country:US
Mailing Address - Phone:614-245-8582
Mailing Address - Fax:
Practice Address - Street 1:5031 FOREST DR
Practice Address - Street 2:SUITE B
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-7088
Practice Address - Country:US
Practice Address - Phone:614-245-8582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization