Provider Demographics
NPI:1396137121
Name:AE WELLNESS, LLC
Entity type:Organization
Organization Name:AE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-225-2151
Mailing Address - Street 1:415 W MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-1801
Mailing Address - Country:US
Mailing Address - Phone:573-225-2151
Mailing Address - Fax:
Practice Address - Street 1:415 W MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-1801
Practice Address - Country:US
Practice Address - Phone:573-225-2151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies