MEDICARE: NEW HORIZONS WELLNESS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	DO463	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184621120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW HORIZONS WELLNESS CENTER

Provider Business Mailing Address
First Line	:	300 N EDWARDS ST
Second Line	:
City	:	ENTERPRISE
State	:	AL
Zip	:	36330-2508
Country	:	US
Telephone Number	:	334-347-4343
Fax Number	:	334-393-9611

Provider Business Practice Location Address
First Line	:	1018 RUCKER BLVD STE A
Second Line	:
City	:	ENTERPRISE
State	:	AL
Zip	:	36330-3688
Country	:	US
Telephone Number	:	334-347-4343
Fax Number	:	334-393-9611

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. MARK B ELLIS
Credential	:	D.O.
Telephone Number	:	334-347-4343

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	03/27/2018

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Directions to “NEW HORIZONS WELLNESS CENTER ” Practice Location

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