# COMMUNITY WELLNESS CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154965044
- **Authorized official:** NOEL SANGER (PARTNER)
- **Authorized official phone:** (816) 769-1680

## Contact information

- **Practice address:** 707 S ROLAND RD STE 6, ROLAND, OK 74954-5337
- **Practice address phone:** (479) 221-7119
- **Mailing address:** PO BOX 937, ROLAND, OK 74954-0937

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208VP0000X | Pain Medicine Physician | — | NULL | Yes |
| 208VP0000X | Pain Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/04/2019
- **Last updated:** 11/04/2019