| 830 Wellness, Llc | |
|
2210 Bandera Hwy Ste C-2 Kerrville TX 78028-6609 | |
| (903) 576-5677 | |
| Not Available |
| Full Name | 830 Wellness, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2210 Bandera Hwy Ste C-2, Kerrville, Texas |
| Authorized Official Name and Position | Lacy Mcmillon (OWNER) |
| Authorized Official Contact | 9035765677 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 830 Wellness, Llc 477 Lariat Trace Bandera TX 78003 Ph: () - | 830 Wellness, Llc 2210 Bandera Hwy Ste C-2 Kerrville TX 78028-6609 Ph: (903) 576-5677 |
| NPI Number | 1649972043 |
|---|---|
| Provider Enumeration Date | 03/20/2023 |
| Last Update Date | 03/20/2023 |
| Medicare PECOS PAC ID | 2668830894 |
|---|---|
| Medicare Enrollment ID | O20230621001383 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649972043 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Lacy N Mcmillon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316321748 PECOS PAC ID: 3476897596 Enrollment ID: I20181130000707 |
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