Healthcare Provider Details

I. General information

NPI: 1356830251
Provider Name (Legal Business Name): METAIRIE TOTAL WELLNESS CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 VETERANS MEMORIAL BLVD STE B
METAIRIE LA
70005-2637
US

IV. Provider business mailing address

5000 ELDORADO PKWY STE 150-153
FRISCO TX
75033-8695
US

V. Phone/Fax

Practice location:
  • Phone: 800-246-5698
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SALVATORE CAMPO
Title or Position: DO / PHYSICIAN
Credential: DO
Phone: 214-714-5343