Provider Demographics
NPI:1154796969
Name:ALL WELLNESS MEDICAL CENTER LLC
Entity type:Organization
Organization Name:ALL WELLNESS MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRUMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-704-4499
Mailing Address - Street 1:2500 CANYON RD STE A1
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8492
Mailing Address - Country:US
Mailing Address - Phone:928-704-4499
Mailing Address - Fax:928-704-4949
Practice Address - Street 1:2500 CANYON RD STE A1
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8492
Practice Address - Country:US
Practice Address - Phone:928-704-4499
Practice Address - Fax:928-704-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-04
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty