Provider Demographics
NPI:1801503297
Name:CLIO HEALTH CLINIC LLC
Entity type:Organization
Organization Name:CLIO HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:URSULA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LNP
Authorized Official - Phone:334-490-1200
Mailing Address - Street 1:1203 BLUE SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:AL
Mailing Address - Zip Code:36017-2523
Mailing Address - Country:US
Mailing Address - Phone:334-490-1200
Mailing Address - Fax:334-780-1070
Practice Address - Street 1:1203 BLUE SPRINGS ST
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:AL
Practice Address - Zip Code:36017-2523
Practice Address - Country:US
Practice Address - Phone:334-490-1200
Practice Address - Fax:334-780-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-03
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty