Provider Demographics
NPI:1396347514
Name:KEN ADOLPH WELLNESS, LLC
Entity type:Organization
Organization Name:KEN ADOLPH WELLNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:ADOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-750-1348
Mailing Address - Street 1:2911 MEDICAL ARTS ST STE 19A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3329
Mailing Address - Country:US
Mailing Address - Phone:512-585-9594
Mailing Address - Fax:
Practice Address - Street 1:2911 MEDICAL ARTS ST STE 19A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3329
Practice Address - Country:US
Practice Address - Phone:512-686-5935
Practice Address - Fax:737-242-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1215901368Medicaid