Provider Demographics
NPI:1083923338
Name:WESTMISTER VILLAGE WELLNESS CENTER
Entity type:Organization
Organization Name:WESTMISTER VILLAGE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-451-2000
Mailing Address - Street 1:12000 N 90TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-8604
Mailing Address - Country:US
Mailing Address - Phone:480-451-2000
Mailing Address - Fax:480-451-2154
Practice Address - Street 1:12000 N 90TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-8604
Practice Address - Country:US
Practice Address - Phone:480-451-2000
Practice Address - Fax:480-451-2154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC4826261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service