NPIMap

Organization Active NPI

MW Wellness II, LLC

  • Family Medicine Physician
  • Bristol, CT
National Provider Identifier
1558819201
Registry record updated Jun 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MW WELLNESS II, LLC
Practice address
99 Farmington Ave
Bristol, CT 06010-4226
Phone
(813) 228-6334
NPI assigned
Sep 12, 2016
Last updated
Jun 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2023

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

Authorized official

Name
Jodi Despoy
Title
Manager
Phone
(813) 228-6334

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

99 Farmington Ave
Bristol, CT 06010-4226

Mailing address

509 S Hyde Park Ave
Tampa, FL 33606-2266
Phone (813) 228-6763

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D2124643MW Wellness II, LLC99 Farmington Ave, Suite 15, Bristol, CT 06010Certificate of waiverJan 22, 2027

National Provider Directory

National Provider Directory

Locations

99 Farmington Ave
Ste 15
Bristol, CT 06010

99 Farmington Ave
Ste 7
Bristol, CT 06010

155 Hazard Ave
Ste 2
Enfield, CT 06082
Phone (860) 698-6041

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1473638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687737600000",
    "number": "1558819201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 S HYDE PARK AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336062266",
            "telephone_number": "813-228-6763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 FARMINGTON AVE",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060104226",
            "telephone_number": "813-228-6334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MW WELLNESS II, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-12",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-26",
        "status": "A",
        "authorized_official_last_name": "DESPOY",
        "authorized_official_first_name": "JODI",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "813-228-6334"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.