MEDICARE: VIRTUE WELLNESS, 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1477175768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRTUE WELLNESS, LLC

Provider Business Mailing Address
First Line	:	6842 CAINE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-4290
Country	:	US
Telephone Number	:	614-655-4235
Fax Number	:

Provider Business Practice Location Address
First Line	:	6842 CAINE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-4290
Country	:	US
Telephone Number	:	614-655-4235
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER & NURSE PRACTITIONER
Name	:	TIFFANY MINDIGO
Credential	:	APRN, NP-C
Telephone Number	:	614-657-7001

Provider Enumeration Date	:	05/11/2020
Last Update Date	:	12/20/2021

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