=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346534765
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NUWELL MEDICAL GROUP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2011
-----------------------------------------------------
Last Update Date | 06/25/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 315 N TRAVIS ST SUITE C5
-----------------------------------------------------
City | SHERMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75090-0028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-680-2239
-----------------------------------------------------
Fax | 214-717-4162
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 315 N TRAVIS ST SUITE C5
-----------------------------------------------------
City | SHERMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75090-0028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-680-2239
-----------------------------------------------------
Fax | 214-717-4162
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMIN
-----------------------------------------------------
Name | DONATUS ONWUANAEGBULE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-680-2239
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 014317
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------