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General NPI Number Information
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NPI Number | 1144176512
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Entity Type | Organization
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Legal Business Name | BLACKSBURG WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 03/09/2026
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Last Update Date | 03/09/2026
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Provider Practice Location Address
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Address Line | 105 MCDONALD ST
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City | BLACKSBURG
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State | VA
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Zip | 24060-3420
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Country | US
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Telephone | 540-552-5545
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Fax | 540-552-5568
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Provider Business Mailing Address
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Address Line | 105 MCDONALD ST
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City | BLACKSBURG
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State | VA
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Zip | 24060-3420
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Country | US
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Telephone | 540-552-5545
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Fax | 540-552-5568
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MARY-ELLEN MICK
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Credential | DO
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Telephone | 540-552-5545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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