Abide Health & Wellness LLC

Key facts

NPI

1144905985

Entity type

Organization (NPI type 2)

Primary specialty

Geriatric Medicine (Internal Medicine) Physician 207RG0300X

Legal business name

ABIDE HEALTH & WELLNESS LLC

Practice address

3113 Wesley Way Ste 2
Dothan, AL 36305-2004

Phone

(334) 203-4145

Fax

(334) 245-0335

NPI assigned

Jun 20, 2023

Organization subpart

No

Authorized official

Name

Juanita Titrud Heersink, MD NPI 1659661874

Title

Medical Director

Phone

(205) 807-6482

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Juanita Titrud Heersink, M.D. Geriatric Medicine (Internal Medicine) Physician · Dothan, AL · NPI 1659661874
  Medicare reassignment NPD Authorized official AL · GERIATRIC MEDICINE

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare participation

Medicare fee-for-service enrollment

Enrolled in AL

Medicare enrollment records

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 6, 2023.

{
    "created_epoch": "1687219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701820800000",
    "number": "1144905985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3113 WESLEY WAY STE 2",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363052004",
            "telephone_number": "334-203-4145",
            "fax_number": "334-245-0335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3113 WESLEY WAY STE 2",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363052004",
            "telephone_number": "334-203-4145",
            "fax_number": "334-245-0335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABIDE HEALTH & WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-20",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A",
        "authorized_official_last_name": "HEERSINK",
        "authorized_official_first_name": "JUANITA",
        "authorized_official_middle_name": "TITRUD",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "205-807-6482",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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