Healthcare Provider Details

I. General information

NPI: 1306603238
Provider Name (Legal Business Name): MBS WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 N MITTHOEFER RD STE A
INDIANAPOLIS IN
46229-2461
US

IV. Provider business mailing address

1002 N MITTHOEFER RD STE A
INDIANAPOLIS IN
46229-2461
US

V. Phone/Fax

Practice location:
  • Phone: 317-985-4885
  • Fax:
Mailing address:
  • Phone: 317-985-4885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BROOKE D RATCLIFFE
Title or Position: MANAGER
Credential: NP
Phone: 317-985-4885