| Comprehensive Wellness Center Llc | |
|
2535 Georgetown Rd Nw Cleveland TN 37312-4101 | |
| (423) 389-8000 | |
| Not Available |
| Full Name | Comprehensive Wellness Center Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2535 Georgetown Rd Nw, Cleveland, Tennessee |
| Authorized Official Name and Position | Walter W Rucker (OWNER) |
| Authorized Official Contact | 4233898000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Comprehensive Wellness Center Llc 2535 Georgetown Rd Nw Cleveland TN 37312-4101 Ph: () - | Comprehensive Wellness Center Llc 2535 Georgetown Rd Nw Cleveland TN 37312-4101 Ph: (423) 389-8000 |
| NPI Number | 1568733863 |
|---|---|
| Provider Enumeration Date | 01/18/2012 |
| Last Update Date | 01/27/2012 |
| Medicare PECOS PAC ID | 9133387012 |
|---|---|
| Medicare Enrollment ID | O20120223000333 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568733863 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 28924 (Tennessee) | Primary |
| Provider Name | Walter W Rucker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386644094 PECOS PAC ID: 2163511742 Enrollment ID: I20071204000841 |
| Provider Name | Lauryn Taylor Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215447990 PECOS PAC ID: 9335405729 Enrollment ID: I20171118000152 |
| Provider Name | Regina Jill Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114545050 PECOS PAC ID: 6709233398 Enrollment ID: I20231102003244 |
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