=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427542422
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDWELL GROUP INTERNATIONAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2018
-----------------------------------------------------
Last Update Date | 05/12/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2925 E SOUTH ST
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32803-6459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-780-0759
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2925 E SOUTH ST
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32803-6459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-780-0759
-----------------------------------------------------
Fax | 888-344-9692
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING DIRECTOR
-----------------------------------------------------
Name | MR. MAJOR R CAUSING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-780-0759
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------