# WILD HEALTH URI CLINIC, LLC

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

## Provider details

- **NPI number:** 1215532759
- **Authorized official:** MR. PHILLIP ANDREW WILLIFORD MSPAS, PA-C (CHIEF MEDICAL ADMINISTRATIVE OFFICE)
- **Authorized official phone:** (859) 439-0400

## Contact information

- **Practice address:** 881 CORPORATE DR, LEXINGTON, KY 40503-2748
- **Practice address phone:** (859) 757-1949
- **Mailing address:** 535 WELLINGTON WAY STE 330, LEXINGTON, KY 40503-1331
- **Mailing address phone:** (859) 439-0400
- **Mailing address fax:** (859) 439-0399

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/02/2020
- **Last updated:** 12/02/2020