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General NPI Number Information
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NPI Number | 1912436981
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Entity Type | Organization
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Legal Business Name | RECONNECT WELLNESS WINONA LLC
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Dates
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Enumeration Date | 06/05/2017
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Last Update Date | 06/05/2017
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Provider Practice Location Address
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Address Line | 100 N FRONT ST STE A
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City | WINONA
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State | MS
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Zip | 38967-2220
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Country | US
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Telephone | 662-680-3148
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Fax | 662-620-9890
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Provider Business Mailing Address
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Address Line | PO BOX 3667
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City | TUPELO
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State | MS
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Zip | 38803-3667
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Country | US
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Telephone | 662-680-3148
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Fax | 662-620-9890
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Authorized Official
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Title or Position | MANAGING MEMBER RECONNECT OUTPATIEN
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Name | DOUGLAS M WRIGHT
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Credential |
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Telephone | 662-680-3148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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