Provider Demographics
NPI:1699283887
Name:HEALTH AND WELLNESS URGENT CARE LLC
Entity type:Organization
Organization Name:HEALTH AND WELLNESS URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIGNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-656-2006
Mailing Address - Street 1:1965 CAPITAL CIR NE STE 200
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-8402
Mailing Address - Country:US
Mailing Address - Phone:850-656-2006
Mailing Address - Fax:850-656-2820
Practice Address - Street 1:1965 CAPITAL CIR NE STE 200
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8402
Practice Address - Country:US
Practice Address - Phone:850-656-2006
Practice Address - Fax:850-656-2820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME86907OtherFL LICENSE