Provider Demographics
NPI:1013262351
Name:WELLNESS GROUP, P.C.
Entity Type:Organization
Organization Name:WELLNESS GROUP, P.C.
Other - Org Name:THE WELLNESS GROUP, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLAW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:219-707-5775
Mailing Address - Street 1:PO BOX 1296
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46384-1296
Mailing Address - Country:US
Mailing Address - Phone:219-707-5775
Mailing Address - Fax:219-707-5775
Practice Address - Street 1:802 LAPORTE AVE
Practice Address - Street 2:PORTER HOSPITAL WOUND CARE CENTER
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-5860
Practice Address - Country:US
Practice Address - Phone:219-263-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003905B261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care