MEDICARE: I AM WELLNESS AZ LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QP2300X	Primary Care Clinic/Center
2	261Q00000X	Clinic/Center
3	261QM0850X	Adult Mental Health Clinic/Center
4	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1558190256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I AM WELLNESS AZ LLC

Provider Business Mailing Address
First Line	:	898 N 1200 W STE 201
Second Line	:
City	:	OREM
State	:	UT
Zip	:	84057-3558
Country	:	US
Telephone Number	:	385-499-5349
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 GRAND AVE STE 112
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85017-4507
Country	:	US
Telephone Number	:	480-900-9355
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT, GOVERNMENT PROGRAMS
Name	:	SARA RATNER
Credential	:
Telephone Number	:	480-900-9355

Provider Enumeration Date	:	07/31/2024
Last Update Date	:	09/24/2024

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Directions to “I AM WELLNESS AZ LLC ” Practice Location

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