Healthcare Provider Details

I. General information

NPI: 1144972456
Provider Name (Legal Business Name): NEW MEDICINE HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SE DIXIE HWY
STUART FL
34994-3045
US

IV. Provider business mailing address

510 SE DIXIE HWY
STUART FL
34994-3045
US

V. Phone/Fax

Practice location:
  • Phone: 772-210-6429
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDWARD PEARSON
Title or Position: CEO
Credential: MD
Phone: 561-797-8456