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General NPI Number Information
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NPI Number | 1932008042
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Entity Type | Organization
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Legal Business Name | ORIGINS MEDICAL AND WELLNESS LLC
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Dates
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Enumeration Date | 11/04/2026
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Last Update Date | 11/04/2026
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Provider Practice Location Address
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Address Line | 897 S MADERA WAY
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City | TONTO BASIN
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State | AZ
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Zip | 85553
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Country | US
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Telephone | 928-978-6262
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 253
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City | TONTO BASIN
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State | AZ
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Zip | 85553-0253
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Country | US
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Telephone | 928-951-4120
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | MRS. KRISTIN ANN WOODS
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Credential | WOODS
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Telephone | 928-951-4120
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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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