Grapevine Total Wellness PLLC

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

Legal business name

GRAPEVINE TOTAL WELLNESS PLLC

Practice address

1000 W St Hwy 114
Grapevine, TX 76051-3987

Phone

(800) 246-5698

NPI assigned

May 22, 2019

Last updated

Jun 11, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

MODERN MALE T-CLINIC, P.A.As reported in NPPES

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

Authorized official

Name

Salvatore Campo, DO

Title

Physician/President

Phone

(800) 246-5698

Specialties & licenses 1

Addresses

Part of

Modern Male T-Clinic PA

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Modern Male T-Clinic, P.a.

  • General Practice Physician
  • Dallas, TX
  • NPI 1518389022
  NPPES parent name

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.

• Gary Watkins, PA

  • Physician Assistant
  • Grand Prairie, TX
  • NPI 1225336522
  NPD (past)

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

{
    "created_epoch": "1558483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1215594577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 ELDORADO PKWY STE 150-153",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750338695",
            "telephone_number": "800-246-5698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W ST HWY 114",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760513987",
            "telephone_number": "800-246-5698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAPEVINE TOTAL WELLNESS PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MODERN MALE T-CLINIC, P.A.",
        "enumeration_date": "2019-05-22",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "CAMPO",
        "authorized_official_first_name": "SALVATORE",
        "authorized_official_title_or_position": "PHYSICIAN/PRESIDENT",
        "authorized_official_telephone_number": "800-246-5698",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grapevine Pediatric Clinic, PA
• Grapevine Pharmacy, Inc
• Grapevine Radiology Associates
• Grapevine Rheumatology Clinic,LLC
• Grapevine Smiles PLLC (DFW Smiles)
• Grapevine Valley Hope
• Nathan Lynn Graves, M.D.
• Grayson Interventional Pain Center
• Greater Southwest Medical Associates
• Greater Southwest Medical Associates

• Adult Medicine Physician in Grapevine, TX
• Providers in Grapevine, TX by specialty
• Adult Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.