MEDICARE: THE WELL LIFE INTEGRATIVE HEALTH 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	261QI0500X	Infusion Therapy Clinic/Center

General Provider Information

NPI Number	:	1730807579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WELL LIFE INTEGRATIVE HEALTH INC

Provider Business Mailing Address
First Line	:	72240 DOGWOOD RD
Second Line	:
City	:	ABITA SPRINGS
State	:	LA
Zip	:	70420-2966
Country	:	US
Telephone Number	:	985-807-8148
Fax Number	:

Provider Business Practice Location Address
First Line	:	72240 DOGWOOD RD
Second Line	:
City	:	ABITA SPRINGS
State	:	LA
Zip	:	70420-2966
Country	:	US
Telephone Number	:	985-807-8148
Fax Number	:

Authorized Official
Title or Position	:	SHAREHOLDER
Name	:	MEGHAN GADDIS
Credential	:	MD
Telephone Number	:	337-298-1667

Provider Enumeration Date	:	08/18/2022
Last Update Date	:	08/18/2022

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