Advanced Wellness Group Inc

Primary specialty

Ph.D. Medical GeneticsTaxonomy code 170100000X

License

K0722 Issued in TX

Legal business name

ADVANCED WELLNESS GROUP INC

Practice address

2705 E Quinlan Pkwy
Quinlan, TX 75474-8688

Phone

(903) 447-5470

NPI assigned

Dec 11, 2007

Last updated

Oct 17, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kenneth Ronald Dority, D.O.NPI 1659313328

Title

Supervising Physician

Phone

(903) 447-5470

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kenneth Ronald Dority, D.O.

  • Family Medicine Physician
  • Arlington, TX
  • NPI 1659313328
  NPD (past) Authorized official
• George Richard Rivaux, MD

  • Surgical Assistant
  • Houston, TX
  • NPI 1588063887
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1003099235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 789",
            "city": "QUINLAN",
            "state": "TX",
            "postal_code": "754740014",
            "telephone_number": "903-447-5470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2705 E QUINLAN PKWY",
            "city": "QUINLAN",
            "state": "TX",
            "postal_code": "754748688",
            "telephone_number": "903-447-5470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED WELLNESS GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-11",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "DORITY",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "RONALD",
        "authorized_official_title_or_position": "SUPERVISING PHYSICIAN",
        "authorized_official_telephone_number": "903-447-5470",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "170100000X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Ph.D. Medical Genetics",
            "state": "TX",
            "license": "K0722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ph.D. Medical Genetics in Quinlan, TX
• Providers in Quinlan, TX by specialty
• Ph.D. Medical Genetics in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.