| Rockwall Complete Healing And Wellness | |
|
2455 Ridge Rd Ste 151 Rockwall TX 75087-5538 | |
| (972) 771-8900 | |
| Not Available |
| Full Name | Rockwall Complete Healing And Wellness |
|---|---|
| Speciality | Clinic/Center |
| Location | 2455 Ridge Rd Ste 151, Rockwall, Texas |
| Authorized Official Name and Position | Dominique M Robinson (OWNER) |
| Authorized Official Contact | 9727718900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rockwall Complete Healing And Wellness 2455 Ridge Rd Ste 151 Rockwall TX 75087-5538 Ph: (972) 771-8900 | Rockwall Complete Healing And Wellness 2455 Ridge Rd Ste 151 Rockwall TX 75087-5538 Ph: (972) 771-8900 |
| NPI Number | 1912515404 |
|---|---|
| Provider Enumeration Date | 07/21/2020 |
| Last Update Date | 03/05/2021 |
| Medicare PECOS PAC ID | 3971919499 |
|---|---|
| Medicare Enrollment ID | O20210309000754 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912515404 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Dana C Logwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114393154 PECOS PAC ID: 0547569535 Enrollment ID: I20160426000176 |
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