WELLNESS FOR LIFE MEDICAL LLC (NPI# 1336460237) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336460237 |
| Entity Type | Organization |
| Organization Name | WELLNESS FOR LIFE MEDICAL LLC |
| Practice Address |
3250 Maple Ave Terre Haute IN 47804-1727 |
| Mailing Address |
Po Box 2084 Terre Haute IN 47802-0084 |
| Practice Telephone | 8776047106 |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2010-06-15 |
| Authorized Official Name | IGOR KOZUNOV (CEO) |
| Authorized Official Telephone | 5155567092 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972011815 | Wellness for Life Medical LLC | Clinic/Center | 3487 S 4th St, Terre Haute, IN 47802 | 2018-01-12 |
| Street Address |
3250 MAPLE AVE |
| City | TERRE HAUTE |
| State | IN |
| Zip Code | 47804-1727 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558822486 | Andrew Obannon | Chiropractor | 3250 Maple Ave, Terre Haute, IN 47804-1727 | 2019-03-25 |
| 1275072811 | Rebecca Kay Barger | Nurse Practitioner | 3250 Maple Ave, Terre Haute, IN 47804-1727 | 2017-02-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568971885 | Tiffany Marshall | Physical Therapist | North At Uap Bone & Joint Center, Lower Level 1725 North 5th Street, Terre Haute, IN 47804 | 2017-09-29 |
| 1336565423 | Deondra Allison Cottrill | Physical Therapy Assistant | 1725 N. 5th Street, Union Hospital Therapy Services, Terre Haute, IN 47804 | 2014-03-13 |
| 1043635170 | Patricia Klos | Physical Therapy Assistant | 1606 Nth 7th Street, Terre Haute, IN 47804 | 2014-02-26 |
| 1043565476 | Debra Denehie Hills | Registered Nurse | 620 8th Avenue, Terre Haute, IN 47804 | 2012-07-23 |
| 1841503257 | Meredeth Su Gray | Dentist | 1608 Lafayette Avenue, Terre Haute, IN 47804 | 2010-07-15 |
| 1083946628 | John Barton, Lpt | Health Maintenance Organization | 1818 N 3rd Street, Terre Haute, IN 47804 | 2010-02-08 |
| 1750584009 | Kool Smiles In-3, PC | Dentist | 1800 Fort Harrison Rd, Terra Haute, IN 47804 | 2007-06-06 |
| 1619006988 | Union Hospital Inc | Student in an Organized Health Care Education/Training Program | 1513 N 6 1-2 Street, Terre Haute, IN 47804 | 2007-03-05 |
| 1730243080 | John Lee Nichols | Dentist | 1246 Maple Ave, Terre Haute, IN 47804 | 2006-12-21 |
| 1093894057 | Isaac N Mitre | Obstetrics & Gynecology | 1623 N 4th Street, Terre Haute, IN 47804 | 2006-11-02 |
| Find all providers in zip 47804 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972011815 | Wellness for Life Medical LLC | Clinic/Center | 3487 S 4th St, Terre Haute, IN 47802 | 2018-01-12 |
| 1407153554 | Associated Physicians of Indiana LLC | Clinic/Center | 3051 S Us Highway 41, Terre Haute, IN 47802-3791 | 2011-02-24 |
| 1548560543 | Grace Lee Walker Md PC | Clinic/Center | 476 Buckeye St, Terre Haute, IN 47804-4079 | 2010-10-25 |
| 1003962549 | Illiana Internal Medicine, L.L.C. | Clinic/Center | 1332 N 7th St, Terre Haute, IN 47807-1004 | 2007-01-26 |
| 1023027190 | Union Hospital Inc | Clinic/Center | 4001 Wabash Ave, Terre Haute, IN 47803-1647 | 2006-08-06 |
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|---|---|---|---|---|
| 1306453626 | Calvary Assembly of God of Demotte, Inc. | Clinic/Center | 1317 15th St. Se, Demotte, IN 46310-9393 | 2020-09-30 |
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| 1952924896 | W. Lafayette Health Center | Clinic/Center | 2701b Kent Ave, W Lafayette, IN 47906-1350 | 2020-05-27 |
| 1710525175 | Proactive - South Newton | Clinic/Center | 1388 South 50 East, Kentland, IN 47951 | 2019-12-17 |
| 1902443781 | Proactive - Edinburgh Dpc | Clinic/Center | 220 N Pleasant St, Edinburgh, IN 46124-1300 | 2019-11-29 |
| 1063058311 | Proactive - Eastern Pulaski | Clinic/Center | 715 School Dr, Winamac, IN 46996-1584 | 2019-11-21 |
| 1275179541 | Proactive - New Prairie | Clinic/Center | 605 E Michigan St, Rolling Prairie, IN 46371-9576 | 2019-11-21 |
| 1982255667 | Careatc | Clinic/Center | 59427 County Road 13, Elkhart, IN 46517-3503 | 2019-09-24 |
| 1134777824 | Activate Healthcare - Mcoe Clinic | Clinic/Center | 6920 Parkdale Pl Ste 100, Indianapolis, IN 46254-5604 | 2019-08-27 |
| 1457906141 | With Dignity Too LLC | Clinic/Center | 1958 West Boulivard, Kokomo, IN 46902 | 2019-08-08 |
| Find all providers with the same taxonomy | ||||
| City | TERRE HAUTE |
| Zip Code | 47804 |
Please comment or provide details below to improve the information on WELLNESS FOR LIFE MEDICAL LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.