Provider Demographics
NPI:1366728016
Name:COLUMBUS MEDICAL WELLNESS CENTER 4 U, INC
Entity type:Organization
Organization Name:COLUMBUS MEDICAL WELLNESS CENTER 4 U, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:0WNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:P
Authorized Official - Last Name:MONSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:727-259-3889
Mailing Address - Street 1:3081 ROOSEVELT BLVD
Mailing Address - Street 2:300
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3422
Mailing Address - Country:US
Mailing Address - Phone:727-259-3889
Mailing Address - Fax:
Practice Address - Street 1:3081 ROOSEVELT BLVD
Practice Address - Street 2:300
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3422
Practice Address - Country:US
Practice Address - Phone:727-259-3889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82686261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty