Provider Demographics
NPI:1023863388
Name:MIDTOWN HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:MIDTOWN HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ILENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYKIN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-NP-C
Authorized Official - Phone:251-533-3143
Mailing Address - Street 1:602 BEL AIR BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-3502
Mailing Address - Country:US
Mailing Address - Phone:251-533-3143
Mailing Address - Fax:251-650-1525
Practice Address - Street 1:602 BEL AIR BLVD STE 9
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3502
Practice Address - Country:US
Practice Address - Phone:251-533-3143
Practice Address - Fax:251-650-1525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-20
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL177618Medicaid