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General NPI Number Information
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NPI Number | 1902269715
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Entity Type | Organization
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Legal Business Name | COMMUNITY WELLNESS CLINIC, LLP
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Dates
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Enumeration Date | 03/30/2016
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 201 ENTERPRISE ROW SUITE 12
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City | CONROE
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State | TX
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Zip | 77301-4448
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Country | US
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Telephone | 936-760-2784
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Fax | 936-760-1950
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Provider Business Mailing Address
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Address Line | 201 ENTERPRISE ROW SUITE 12
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City | CONROE
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State | TX
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Zip | 77301-4448
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Country | US
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Telephone | 936-760-2784
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Fax | 936-760-1950
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | MR. KERRY GREGORY
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Credential |
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Telephone | 936-760-2797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0005X
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Taxonomy Name | Ambulatory Family Planning Facility
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License Number |
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License Number State |
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