Wellvana New Mexico LLC
Exclusive Provider Organization in Nashville, TN. Organization (NPI-2).
NPI number1982308680
StatusActive
Last updated in NPPESMar 28, 2023
Details
- NPI
- 1982308680
- Entity type
- Organization (NPI-2)
- Legal business name
- Wellvana New Mexico LLC
- Organization subpart
- Yes
- Enumeration date
- Mar 28, 2023
- Certification date
- May 4, 2021
- Last updated
- Mar 28, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 302F00000X | Exclusive Provider Organization | – | – | Yes |
Practice location
20 Burton Hills Blvd Ste 100Nashville, TN 37215-6409
Phone 860-501-7908
Mailing address
40 Burton Hills Blvd Ste 100Nashville, TN 37215-6291
Authorized official
Catherine Smith
Vp Operations
8605017908
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