Provider Demographics
NPI:1255045324
Name:UNITED MEDICAL WELLNESS COMPLEX, LLC
Entity type:Organization
Organization Name:UNITED MEDICAL WELLNESS COMPLEX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:TAFT
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-940-4195
Mailing Address - Street 1:892 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4509
Mailing Address - Country:US
Mailing Address - Phone:769-567-1304
Mailing Address - Fax:800-951-3880
Practice Address - Street 1:892 CENTRE ST
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4509
Practice Address - Country:US
Practice Address - Phone:769-251-2098
Practice Address - Fax:800-394-6187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty