Provider Demographics
NPI:1649613621
Name:MIDLANDS MEDICAL WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:MIDLANDS MEDICAL WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANDRETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RHOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-223-9328
Mailing Address - Street 1:205 WATER HICKORY WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7550
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 SPRINGTREE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-8614
Practice Address - Country:US
Practice Address - Phone:803-223-9328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22453261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center