# SOUTHWELLNESS MEDICAL LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1366099533
- **Authorized official:** DR. TYLER JOHN SOUTHWELL MD (CEO)
- **Authorized official phone:** (480) 991-9271

## Contact information

- **Practice address:** 10599 N TATUM BLVD STE F151, PARADISE VALLEY, AZ 85253-1053
- **Practice address phone:** (480) 991-9271
- **Practice address fax:** (844) 284-7758
- **Mailing address:** 10599 N TATUM BLVD STE F151, PARADISE VALLEY, AZ 85253-1053
- **Mailing address phone:** (480) 991-9271
- **Mailing address fax:** (844) 284-7758

## Taxonomy

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

## Other

- **Enumeration date:** 08/22/2019
- **Last updated:** 10/15/2020