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General NPI Number Information
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NPI Number | 1962648006
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Entity Type | Organization
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Legal Business Name | THE WELLNESS MANAGEMENT GROUP
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Dates
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Enumeration Date | 12/19/2008
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Last Update Date | 01/05/2009
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Provider Practice Location Address
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Address Line | 2404 CAROLINE ST
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City | HOUSTON
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State | TX
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Zip | 77004-1016
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Country | US
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Telephone | 713-524-4803
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Fax | 713-524-4801
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Provider Business Mailing Address
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Address Line | 2404 CAROLINE ST
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City | HOUSTON
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State | TX
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Zip | 77004-1016
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Country | US
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Telephone | 713-524-4803
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Fax | 713-524-4801
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. LAMONT RATCLIFF
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Credential |
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Telephone | 713-524-4803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G7943
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | G7943
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G7943
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G7943
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License Number State | TX
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