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General NPI Number Information
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NPI Number | 1821413311
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Entity Type | Organization
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Legal Business Name | PHYSICIAN WELLNESS, LLC
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Dates
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Enumeration Date | 02/20/2014
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Last Update Date | 02/20/2014
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Provider Practice Location Address
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Address Line | 825 DAVIS ST E
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City | BLACKSBURG
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State | VA
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Zip | 24060-7009
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Country | US
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Telephone | 540-953-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 825 DAVIS ST E
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City | BLACKSBURG
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State | VA
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Zip | 24060-7009
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Country | US
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Telephone | 540-953-3300
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KONRAD H KAEDING
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Credential |
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Telephone | 302-593-5904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 0101059231
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License Number State | VA
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