1114531225 NPI number — WESTERFIELD WELLNESS CLINIC LLC

Table of content: DR. DEBORAH DENNEY DOUGLAS M.D. (NPI 1780960005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114531225 NPI number — WESTERFIELD WELLNESS CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERFIELD WELLNESS CLINIC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114531225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2011
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYLIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75098-2011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-404-0425
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 S JACKSON AVE STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYLIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75098-3914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-668-3599
Provider Business Practice Location Address Fax Number:
833-215-7803
Provider Enumeration Date:
09/04/2020

Additional Information

Authorized Official

Authorized Official Last Name:
WESTERFIELD
Authorized Official First Name:
TRANISHIA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
469-668-3599

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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