| Prime Wellness Clinic Llc | |
|
14904 Jefferson Davis Hwy Suite 305 Woodbridge VA 22191-3908 | |
| (571) 492-7702 | |
| (571) 492-7704 |
| Full Name | Prime Wellness Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 14904 Jefferson Davis Hwy, Woodbridge, Virginia |
| Authorized Official Name and Position | Abubakari Welle (PROPRIETOR) |
| Authorized Official Contact | 7035986146 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Wellness Clinic Llc 14904 Jefferson Davis Hwy Suite 305 Woodbridge VA 22191-3908 Ph: (571) 492-7702 | Prime Wellness Clinic Llc 14904 Jefferson Davis Hwy Suite 305 Woodbridge VA 22191-3908 Ph: (571) 492-7702 |
| NPI Number | 1154661395 |
|---|---|
| Provider Enumeration Date | 02/25/2013 |
| Last Update Date | 09/14/2017 |
| Medicare PECOS PAC ID | 4082852702 |
|---|---|
| Medicare Enrollment ID | O20130607000171 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154661395 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 0101245731 (Virginia) | Primary |
| Provider Name | Abubakari Welle |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831320639 PECOS PAC ID: 4880732130 Enrollment ID: I20130607000217 |
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