MEDICARE: POZEGA WELLNESS CENTER INC

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	208000000X	Pediatrics Physician	1512	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649467846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POZEGA WELLNESS CENTER INC

Provider Business Mailing Address
First Line	:	5324 MACCORKLE AVE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-2222
Country	:	US
Telephone Number	:	304-925-7001
Fax Number	:	304-925-7234

Provider Business Practice Location Address
First Line	:	5324 MACCORKLE AVE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-2222
Country	:	US
Telephone Number	:	304-925-7001
Fax Number	:	304-925-7234

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MARY C POZEGA
Credential	:	DO
Telephone Number	:	304-925-7001

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	10/02/2007

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Directions to “POZEGA WELLNESS CENTER INC ” Practice Location

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