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General NPI Number Information
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NPI Number | 1780013722
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Entity Type | Organization
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Legal Business Name | BIOTEC WELLNESS, LLC
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Dates
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Enumeration Date | 11/08/2013
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 2684 COUNTY ROAD 037
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City | JASPER
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State | TX
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Zip | 75951-6456
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Country | US
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Telephone | 254-631-3081
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Fax | 512-233-0514
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Provider Business Mailing Address
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Address Line | 2684 COUNTY ROAD 037
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City | JASPER
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State | TX
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Zip | 75951-6456
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Country | US
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Telephone | 254-631-3081
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Fax | 512-233-0514
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JACKIE AUTHEMENT JR.
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Credential |
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Telephone | 254-631-3081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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