NPIMap

Organization Active NPI

Medical Wellness LLC

  • Primary Care Clinic/Center
  • Wolcott, CT
National Provider Identifier
1386023828
Registry record updated May 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
12.004592 Issued in CT
Legal business name
MEDICAL WELLNESS LLC
Practice address
503 Wolcott Rd
#3
Wolcott, CT 06716-2673
Phone
(203) 948-1300
Fax
(888) 372-6480
NPI assigned
May 28, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2015

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

Authorized official

Name
Mr. Steven Paul Jeske, APRN
Title
Owner
Phone
(203) 948-1300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 12.004592 CT Primary

Addresses

Primary practice location

503 Wolcott Rd
#3
Wolcott, CT 06716-2673

Mailing address

503 Wolcott Rd
#3
Wolcott, CT 06716-2673
Phone (203) 948-1300

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1432771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432771200000",
    "number": "1386023828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 WOLCOTT RD",
            "address_2": "#3",
            "city": "WOLCOTT",
            "state": "CT",
            "postal_code": "067162673",
            "telephone_number": "203-948-1300",
            "fax_number": "888-372-6480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 WOLCOTT RD",
            "address_2": "#3",
            "city": "WOLCOTT",
            "state": "CT",
            "postal_code": "067162673",
            "telephone_number": "203-948-1300",
            "fax_number": "888-372-6480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-28",
        "last_updated": "2015-05-28",
        "status": "A",
        "authorized_official_last_name": "JESKE",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-948-1300",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CT",
            "license": "12.004592",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wolcott, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2015; 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.