Healthcare Provider Details

I. General information

NPI: 1851802995
Provider Name (Legal Business Name): NATURAL WELLNESS OF TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 N AZALEA ST STE 31
VICTORIA TX
77901-4151
US

IV. Provider business mailing address

388 METTING RD
GOLIAD TX
77963-3958
US

V. Phone/Fax

Practice location:
  • Phone: 361-485-0449
  • Fax:
Mailing address:
  • Phone: 361-392-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP130832
License Number StateTX

VIII. Authorized Official

Name: TIMOTHY HOLCOMB
Title or Position: OWNER
Credential: FNP
Phone: 361-392-1100