Basic Information
| Provider Information | |||||||||
| NPI: | 1699283887 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTH AND WELLNESS URGENT CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1965 CAPITAL CIR NE STE 200 | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323088402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506562006 | ||||||||
| FaxNumber: | 8506562820 | ||||||||
| Practice Location | |||||||||
| Address1: | 1965 CAPITAL CIR NE STE 200 | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323088402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506562006 | ||||||||
| FaxNumber: | 8506562820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2018 | ||||||||
| LastUpdateDate: | 04/19/2018 | ||||||||
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| AuthorizedOfficialLastName: | MIGNON | ||||||||
| AuthorizedOfficialFirstName: | YVETTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8506562006 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | ME86907 | 01 | FL | FL LICENSE | OTHER |