# MW WELLNESS XII, LLC

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

## Provider details

- **NPI number:** 1346873361
- **Authorized official:** STACEY HEALD (EVP)
- **Authorized official phone:** (813) 228-6334

## Contact information

- **Practice address:** 154 FAUNCE CORNER RD, SUITE F, NORTH DARTMOUTH, MA 02747-1214
- **Practice address phone:** (813) 228-6334
- **Mailing address:** 509 S HYDE PARK AVE, TAMPA, FL 33606-2266

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207QB0002X | Obesity Medicine (Family Medicine) Physician | — | NULL | — |
| 207QB0002X | Obesity Medicine (Family Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 02/18/2020
- **Last updated:** 02/18/2020