Provider Demographics
NPI:1104259282
Name:WELLINGTON WELLNESS AND MEDICAL CENTER
Entity type:Organization
Organization Name:WELLINGTON WELLNESS AND MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIFERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-678-0078
Mailing Address - Street 1:12794 FOREST HILL BLVD STE 18A
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4717
Mailing Address - Country:US
Mailing Address - Phone:954-678-0078
Mailing Address - Fax:954-370-6447
Practice Address - Street 1:12794 FOREST HILL BLVD STE 18A
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4717
Practice Address - Country:US
Practice Address - Phone:954-678-0078
Practice Address - Fax:954-370-6447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty