Provider Demographics
NPI:1750094744
Name:INCEPTIVIA HEALTH & WELLNESS LLC
Entity type:Organization
Organization Name:INCEPTIVIA HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:256-558-5480
Mailing Address - Street 1:1126 MCVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-6029
Mailing Address - Country:US
Mailing Address - Phone:256-558-5480
Mailing Address - Fax:256-376-8102
Practice Address - Street 1:420 4TH ST NW
Practice Address - Street 2:
Practice Address - City:ATTALLA
Practice Address - State:AL
Practice Address - Zip Code:35954-2227
Practice Address - Country:US
Practice Address - Phone:256-558-5480
Practice Address - Fax:256-376-8102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty