Provider Demographics
NPI:1669185625
Name:GALAXY WELLNESS SERVICES LLC
Entity type:Organization
Organization Name:GALAXY WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:903-212-0556
Mailing Address - Street 1:1201 W LOOP 281 STE 302
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2941
Mailing Address - Country:US
Mailing Address - Phone:903-212-0556
Mailing Address - Fax:903-212-3456
Practice Address - Street 1:1201 W LOOP 281 STE 302
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2941
Practice Address - Country:US
Practice Address - Phone:903-212-0556
Practice Address - Fax:903-212-3456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty