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General NPI Number Information
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NPI Number | 1386252757
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Entity Type | Organization
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Legal Business Name | EVENTUS WHOLEHEALTH MIDWEST INC
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Dates
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Enumeration Date | 07/21/2020
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 2100 MIDWAY ST # 3722
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City | COLUMBUS
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State | IN
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Zip | 47201-3722
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Country | US
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Telephone | 260-483-9081
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Fax | 260-483-9196
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Provider Business Mailing Address
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Address Line | PO BOX 1000 DEPT 3063
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City | MEMPHIS
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State | TN
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Zip | 38148-0001
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Country | US
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Telephone | 855-743-2247
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Fax | 260-483-9196
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER RUCCI
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Credential | MD
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Telephone | 855-743-2247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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