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General NPI Number Information
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NPI Number | 1912550765
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Entity Type | Organization
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Legal Business Name | SHAMROCK HEALTH AND WELLNESS CLINIC, LLC
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 100 S MAIN ST
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City | NORTH LIBERTY
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State | IN
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Zip | 46554-7705
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Country | US
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Telephone | 574-656-7625
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 769
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City | NORTH LIBERTY
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State | IN
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Zip | 46554-0769
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAMERA ANDREWS
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Credential |
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Telephone | 574-656-7526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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