| Origin Family Wellness Llc | |
|
1811 Bethlehem Pike Ste A101 Flourtown PA 19031-1111 | |
| (215) 774-9004 | |
| Not Available |
| Full Name | Origin Family Wellness Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1811 Bethlehem Pike Ste A101, Flourtown, Pennsylvania |
| Authorized Official Name and Position | Tatiana Kisluk (MEDICAL PROVIDER) |
| Authorized Official Contact | 2157749004 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Origin Family Wellness Llc 1811 Bethlehem Pike Ste A101 Flourtown PA 19031-1111 Ph: () - | Origin Family Wellness Llc 1811 Bethlehem Pike Ste A101 Flourtown PA 19031-1111 Ph: (215) 774-9004 |
| NPI Number | 1477283042 |
|---|---|
| Provider Enumeration Date | 06/15/2022 |
| Last Update Date | 06/21/2022 |
| Medicare PECOS PAC ID | 9638550734 |
|---|---|
| Medicare Enrollment ID | O20220721000031 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477283042 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Tatiana Kisluk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649673641 PECOS PAC ID: 1153543798 Enrollment ID: I20160120000862 |
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