Healthcare Provider Details

I. General information

NPI: 1174384044
Provider Name (Legal Business Name): M&S WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HOLIDAY PLAZA DR STE 176
MATTESON IL
60443-2236
US

IV. Provider business mailing address

1014 REGENT DR
MATTESON IL
60443-3089
US

V. Phone/Fax

Practice location:
  • Phone: 833-326-5273
  • Fax: 708-810-8169
Mailing address:
  • Phone: 833-326-5273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE RIGGINS
Title or Position: OWNER
Credential:
Phone: 708-543-6384