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General NPI Number Information
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NPI Number | 1477215069
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Entity Type | Organization
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Legal Business Name | ULTIMATE WELLNESS PROVIDERS CO
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Dates
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Enumeration Date | 10/11/2021
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 4914 BISSONNET ST STE 101
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City | BELLAIRE
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State | TX
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Zip | 77401-4047
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Country | US
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Telephone | 877-768-4897
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Fax | 832-213-3075
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Provider Business Mailing Address
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Address Line | 4914 BISSONNET ST STE 101
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City | BELLAIRE
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State | TX
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Zip | 77401-4047
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Country | US
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Telephone | 877-768-4897
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Fax | 832-213-3075
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Authorized Official
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Title or Position | FOUNDER/ CEO
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Name | LASONJA MALONE
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Credential | CCMA
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Telephone | 877-768-4897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202C00000X
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Taxonomy Name | Independent Medical Examiner Physician
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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 | 251F00000X
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Taxonomy Name | Home Infusion Agency
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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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 | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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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 | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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Taxonomy #6
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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