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Contact Information

INDWELL HEALTH AND WELLNESS.LLC
1019A VISTA PARK DR
FOREST, VA24551-4901
 Phone: 434-515-0419
 Fax: 844-693-9305
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Allergy & Immunology

207K00000X 03 Physician/Allergy/ Immunology
 

Pediatric Allergy/Immunology

2080P0201X 37 Physician/Pediatric Medicine
 

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for INDWELL HEALTH AND WELLNESS.LLC

NPI Number 1689119646
LBN Legal business name INDWELL HEALTH AND WELLNESS.LLC
Authorized official LUIS MATOS - (MEDICAL DIRECTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 12/30/2016
Last updated 04/12/2018 - About 8 years ago
Identifiers
VA License # 0101056392
VA Medicaid 5804426
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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