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Organization
IV LEAGUE HEALTH & WELLNESS
Active
Organization
IV LEAGUE HEALTH & WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH JACOBO (CREDENTIALING MANAGER)
(325) 374-0821
Entity
Organization
Contact information
Practice address
223 S ABE ST, SAN ANGELO, TX 76903-6305
(325) 655-7969
Mailing address
223 S ABE ST, SAN ANGELO, TX 76903-6305
(325) 655-7969
(325) 655-7976
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QI0500X
Infusion Therapy Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
04/01/2024
Last updated
04/01/2024
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