1912718982 NPI number — TOTALWELL HEALTH CLINIC PLLC

Table of content: (NPI 1912718982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912718982 NPI number — TOTALWELL HEALTH CLINIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTALWELL HEALTH CLINIC PLLC
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:
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:
1912718982
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1425 TUSKAWILLA RD STE 221
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32708-5289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-257-9947
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1425 TUSKAWILLA RD STE 221
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32708-5289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-257-9947
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2025

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
PHYSICIAN/ CO-OWNER
Authorized Official Telephone Number:
910-257-9947

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1851555759 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1760442834 . This is a "NPI NUMBER DR. JOSEPH JOHNSON" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1851555759 . This is a "NPI NUMBER DR. HEIDY ORMENO LOPEZ" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: ME109010 . This is a "FLORIDA MEDICAL LICENSE DR. HEIDY ORMENO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1760442834 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: ME144087 . This is a "FLORIDA MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 01054071A . This is a "INDIANA MEDICAL LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 65445 . This is a "GEORGIA MEDICAL LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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