Provider Demographics
NPI:1962017780
Name:B & G WELLNESS INC
Entity Type:Organization
Organization Name:B & G WELLNESS INC
Other - Org Name:B & G CLINICAL SERVICES INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUMPUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-730-8445
Mailing Address - Street 1:4848 GREGORY RD STE A
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-9628
Mailing Address - Country:US
Mailing Address - Phone:734-726-5421
Mailing Address - Fax:949-543-2300
Practice Address - Street 1:4848 GREGORY RD STE A
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-9628
Practice Address - Country:US
Practice Address - Phone:734-726-5421
Practice Address - Fax:949-543-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2023-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty