IV League Health & Wellness

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

IV LEAGUE HEALTH & WELLNESS

Practice address

223 S Abe St
San Angelo, TX 76903-6305

Phone

(325) 655-7969

NPI assigned

Apr 1, 2024

Organization subpart

No

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

Authorized official

Name

Elizabeth Jacobo

Title

Credentialing Manager

Phone

(325) 374-0821

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1711929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711929600000",
    "number": "1619728243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "223 S ABE ST",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769036305",
            "telephone_number": "325-655-7969",
            "fax_number": "325-655-7976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 S ABE ST",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769036305",
            "telephone_number": "325-655-7969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IV LEAGUE HEALTH & WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-01",
        "last_updated": "2024-04-01",
        "certification_date": "2024-03-31",
        "status": "A",
        "authorized_official_last_name": "JACOBO",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "325-374-0821"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in San Angelo, TX
• Providers in San Angelo, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2024; 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.