Provider Demographics
NPI:1720641491
Name:MTC WELLNESS, LLC
Entity Type:Organization
Organization Name:MTC WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-571-7615
Mailing Address - Street 1:280 RIPKA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127-1125
Mailing Address - Country:US
Mailing Address - Phone:267-571-7615
Mailing Address - Fax:
Practice Address - Street 1:255 S 17TH ST STE 1601
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6216
Practice Address - Country:US
Practice Address - Phone:267-571-7615
Practice Address - Fax:610-668-8609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty