The Wellness Clinic

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD21306 Issued in OR

Legal business name

THE WELLNESS CLINIC

Practice address

2395 NW Stewart Pkwy
Roseburg, OR 97470-5653

Phone

(541) 957-5750

Fax

(541) 957-5766

NPI assigned

Mar 13, 2008

Last updated

Mar 13, 2008By 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

Kim D Hammer

Title

Office Manager

Phone

(541) 957-5750

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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.

• Connie L Grady, MD

  • Internal Medicine Physician
  • Roseburg, OR
  • NPI 1740266816
  NPD (past)

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

{
    "created_epoch": "1205366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205366400000",
    "number": "1184895518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2395 NW STEWART PARKWAY",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "97470",
            "telephone_number": "541-957-5750",
            "fax_number": "541-957-5766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2395 NW STEWART PKWY",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974705653",
            "telephone_number": "541-957-5750",
            "fax_number": "541-957-5766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WELLNESS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-13",
        "last_updated": "2008-03-13",
        "status": "A",
        "authorized_official_last_name": "HAMMER",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "541-957-5750"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD21306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287168",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Virginia Ruth Terry, R.D.
• Marc R Tetrick
• Stephen B. Tharp, LISW
• Mukesh K Thawani, M.D.
• Katherine Thayer
• Therapeutic Associates Inc (TAI Central Physical Therapy)
• Therapeutic Services LLC (Therapy Plus)
• Ginger Jean Thibedeau, LMT, MMP, #13728 ORE
• Thomas H Thompson MD PC
• Thomas Leech, O.D.,P.C.

• Internal Medicine Physician in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Internal Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2008; 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.