Provider Demographics
NPI:1184296162
Name:HEALTHWISE WELLNESS LLC
Entity type:Organization
Organization Name:HEALTHWISE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOCHI
Authorized Official - Middle Name:
Authorized Official - Last Name:AMAGWULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-454-4354
Mailing Address - Street 1:4014 OLD WARREN RD
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6110
Mailing Address - Country:US
Mailing Address - Phone:870-454-4354
Mailing Address - Fax:870-390-4781
Practice Address - Street 1:4014 OLD WARREN RD
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6110
Practice Address - Country:US
Practice Address - Phone:870-454-4354
Practice Address - Fax:870-390-4781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-11
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty