Organization
WILD HEALTH URI CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILLIP ANDREW WILLIFORD MSPAS, PA-C (CHIEF MEDICAL ADMINISTRATIVE OFFICE)
(859) 439-0400
Entity
Organization
Contact information
Practice address
881 CORPORATE DR, LEXINGTON, KY 40503-2748
(859) 757-1949
Mailing address
535 WELLINGTON WAY STE 330, LEXINGTON, KY 40503-1331
(859) 439-0400
(859) 439-0399
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
12/02/2020
Last updated
12/02/2020
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