Provider Demographics
NPI:1801283882
Name:MINGO COUNTY FAMILY WELLNESS CENTER LLC
Entity type:Organization
Organization Name:MINGO COUNTY FAMILY WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/HEALTHCARE PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:COLEGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:304-475-3700
Mailing Address - Street 1:872 ROUTE 65
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-7497
Mailing Address - Country:US
Mailing Address - Phone:304-475-3700
Mailing Address - Fax:304-475-3780
Practice Address - Street 1:872 ROUTE 65
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-7497
Practice Address - Country:US
Practice Address - Phone:304-475-3700
Practice Address - Fax:304-475-3780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care