Provider Demographics
NPI:1295313476
Name:SAN ANGELO WELLNESS CENTER PLLC
Entity type:Organization
Organization Name:SAN ANGELO WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HARZKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-763-8094
Mailing Address - Street 1:4400 BUFFALO GAP RD # 2400C
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-2723
Mailing Address - Country:US
Mailing Address - Phone:325-695-4133
Mailing Address - Fax:325-695-6386
Practice Address - Street 1:602 S ABE ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-6732
Practice Address - Country:US
Practice Address - Phone:325-939-2187
Practice Address - Fax:325-655-6286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty