Provider Demographics
NPI:1356778195
Name:WELLNESS & INJURY MEDICAL CENTER
Entity type:Organization
Organization Name:WELLNESS & INJURY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:432-363-8020
Mailing Address - Street 1:4682 E UNIVERSITY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-8178
Mailing Address - Country:US
Mailing Address - Phone:432-363-8020
Mailing Address - Fax:432-363-0962
Practice Address - Street 1:4682 E UNIVERSITY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-8178
Practice Address - Country:US
Practice Address - Phone:432-363-8020
Practice Address - Fax:432-363-0962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX792081363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty