MEDICARE: GLOBAL WELLNESS CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1386102226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLOBAL WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	2525 TILLER LN STE 107
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-2267
Country	:	US
Telephone Number	:	614-588-9830
Fax Number	:

Provider Business Practice Location Address
First Line	:	3350 CLEVELAND AVE STE 1964
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-3677
Country	:	US
Telephone Number	:	614-588-9830
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YASSIN MATAN
Credential	:
Telephone Number	:	614-588-9830

Provider Enumeration Date	:	03/11/2019
Last Update Date	:	03/11/2019

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