Provider Demographics
NPI:1033934575
Name:903 HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:903 HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-991-8557
Mailing Address - Street 1:PO BOX 1192
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:TX
Mailing Address - Zip Code:75791-1192
Mailing Address - Country:US
Mailing Address - Phone:903-991-8557
Mailing Address - Fax:903-352-3297
Practice Address - Street 1:403 STATE HIGHWAY 110 N
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:TX
Practice Address - Zip Code:75791-3109
Practice Address - Country:US
Practice Address - Phone:903-991-8557
Practice Address - Fax:903-352-3297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty