MEDICARE: MEDI HEALTH AND 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1497253322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDI HEALTH AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	80 LAMBERT LIND HWY
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-1071
Country	:	US
Telephone Number	:	401-739-7900
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 LAMBERT LIND HWY
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-1071
Country	:	US
Telephone Number	:	401-739-7900
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	JOHN MIGLIACCIO
Credential	:
Telephone Number	:	401-739-7900

Provider Enumeration Date	:	01/25/2018
Last Update Date	:	01/25/2018

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