MEDICARE: MBS WELLNESS LLC

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1306603238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MBS WELLNESS LLC

Provider Business Mailing Address
First Line	:	1002 N MITTHOEFER RD STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-2461
Country	:	US
Telephone Number	:	317-985-4885
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 N MITTHOEFER RD STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-2461
Country	:	US
Telephone Number	:	317-985-4885
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	BROOKE D RATCLIFFE
Credential	:	NP
Telephone Number	:	317-985-4885

Provider Enumeration Date	:	03/06/2024
Last Update Date	:	03/06/2024

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Directions to “MBS WELLNESS LLC ” Practice Location

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