MEDICARE: SILER CITY WELLNESS SOLUTIONS, 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	:	1497346183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILER CITY WELLNESS SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	202 E RALEIGH ST STE B
Second Line	:
City	:	SILER CITY
State	:	NC
Zip	:	27344-3559
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 E RALEIGH ST STE B
Second Line	:
City	:	SILER CITY
State	:	NC
Zip	:	27344-3559
Country	:	US
Telephone Number	:	919-663-5541
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANGELYNN FOX
Credential	:
Telephone Number	:	919-663-5541

Provider Enumeration Date	:	01/27/2021
Last Update Date	:	02/12/2021

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