Provider Demographics
NPI:1518405737
Name:MW WELLNESS IV, LLC
Entity type:Organization
Organization Name:MW WELLNESS IV, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF INSURANCE DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:WENDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NONCLERC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-228-6334
Mailing Address - Street 1:611 W HWY 6
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7544
Mailing Address - Country:US
Mailing Address - Phone:254-741-8686
Mailing Address - Fax:254-741-8687
Practice Address - Street 1:611 W HWY 6
Practice Address - Street 2:SUITE 108
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7544
Practice Address - Country:US
Practice Address - Phone:254-741-8686
Practice Address - Fax:254-741-8687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty