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General NPI Number Information
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NPI Number | 1215231980
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Entity Type | Organization
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Legal Business Name | WELLNESS PHYSICIAN SERVICES, PA
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 2611 HARRISON ST 800
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City | WICHITA FALLS
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State | TX
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Zip | 76308-1361
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Country | US
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Telephone | 940-723-5698
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Fax | 940-322-4514
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Provider Business Mailing Address
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Address Line | 2611 HARRISON ST 800
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City | WICHITA FALLS
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State | TX
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Zip | 76308-1361
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Country | US
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Telephone | 940-723-5698
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Fax | 940-322-4514
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID WHITTIKER
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Credential | M.D
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Telephone | 940-723-5698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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