Provider Demographics
NPI:1932490968
Name:WHOLE MEDICINE LLC
Entity Type:Organization
Organization Name:WHOLE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BART
Authorized Official - Middle Name:
Authorized Official - Last Name:TEEUWISSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-621-1848
Mailing Address - Street 1:1595 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2901
Mailing Address - Country:US
Mailing Address - Phone:831-621-1848
Mailing Address - Fax:831-621-1804
Practice Address - Street 1:1595 38TH AVE
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2901
Practice Address - Country:US
Practice Address - Phone:831-621-1848
Practice Address - Fax:831-621-1804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center