Provider Demographics
NPI:1386934628
Name:WELLNESS GROUP LLC
Entity type:Organization
Organization Name:WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MEISSNER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:877-886-7117
Mailing Address - Street 1:1000 N GREEN VALLEY PKWY
Mailing Address - Street 2:SUITE 440 NUMBER 401
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-6170
Mailing Address - Country:US
Mailing Address - Phone:877-886-7117
Mailing Address - Fax:702-943-3313
Practice Address - Street 1:1000 N GREEN VALLEY PKWY
Practice Address - Street 2:SUITE 440 NUMBER 401
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6170
Practice Address - Country:US
Practice Address - Phone:877-886-7117
Practice Address - Fax:702-943-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA030285208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty