Organization Active NPI

MW Wellness VIII, LLC

  • Family Medicine Physician
  • Enfield, CT
National Provider Identifier
1639695935
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 VIII, LLC
Practice address
155 Hazard Ave Ste 2
Enfield, CT 06082
Phone
(813) 228-6763
NPI assigned
Aug 17, 2017
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

155 Hazard Ave Ste 2
Enfield, CT 06082

Mailing address

155 Hazard Ave Ste 2
Enfield, CT 06082-4586
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
07D2151575MW Wellness VIII, LLC155 Hazard Ave, Suite 2, Enfield, CT 06082Certificate of waiverJul 22, 2028

National Provider Directory

National Provider Directory

Locations

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

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1502928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687737600000",
    "number": "1639695935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 HAZARD AVE STE 2",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060824586",
            "telephone_number": "813-228-6763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 HAZARD AVE STE 2",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "06082",
            "telephone_number": "813-228-6763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MW WELLNESS VIII, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-17",
        "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 Enfield, 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.