MEDICARE: MW WELLNESS VENTURES II, 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1437651882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MW WELLNESS VENTURES II, LLC

Provider Business Mailing Address
First Line	:	80 LAMBERT LIND HWY
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-1071
Country	:	US
Telephone Number	:	401-739-7900
Fax Number	:	401-739-7910

Provider Business Practice Location Address
First Line	:	80 LAMBERT LIND HWY
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-1071
Country	:	US
Telephone Number	:	401-739-7900
Fax Number	:	401-739-7910

Authorized Official
Title or Position	:	MANAGER
Name	:	JODI DESPOY
Credential	:
Telephone Number	:	813-228-6334

Provider Enumeration Date	:	03/01/2018
Last Update Date	:	06/26/2023

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