| Wellnessclinic On Wheels | |
|
1747 Fort Smith Blvd Deltona FL 32725-3728 | |
| (202) 834-7722 | |
| Not Available |
| Full Name | Wellnessclinic On Wheels |
|---|---|
| Speciality | Clinic/Center |
| Location | 1747 Fort Smith Blvd, Deltona, Florida |
| Authorized Official Name and Position | El Agathe Asopo Tembeng (OWNER) |
| Authorized Official Contact | 2028347722 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellnessclinic On Wheels 1747 Fort Smith Blvd Deltona FL 32725-3728 Ph: (202) 834-7722 | Wellnessclinic On Wheels 1747 Fort Smith Blvd Deltona FL 32725-3728 Ph: (202) 834-7722 |
| NPI Number | 1750046363 |
|---|---|
| Provider Enumeration Date | 11/08/2021 |
| Last Update Date | 09/09/2022 |
| Medicare PECOS PAC ID | 5294101259 |
|---|---|
| Medicare Enrollment ID | O20221014003050 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750046363 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Jacob K Agamasu |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1194774604 PECOS PAC ID: 6901701846 Enrollment ID: I20031203000695 |
| Provider Name | El Agathe A Tembeng |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548539588 PECOS PAC ID: 8921265984 Enrollment ID: I20120202000052 |
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