Provider Demographics
NPI:1952995615
Name:COMMUNITY WELLNESS MEDICAL ASSOCIATES A PC
Entity type:Organization
Organization Name:COMMUNITY WELLNESS MEDICAL ASSOCIATES A PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TINAMISAN
Authorized Official - Last Name:CATAUSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-827-7273
Mailing Address - Street 1:1821 S BASCOM AVE # 383
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:304 S 4TH ST STE 301
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2081
Practice Address - Country:US
Practice Address - Phone:650-722-2611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty