Organization
INDWELL HEALTH AND WELLNESS.LLC
Active
Other names
Allergy and Asthma of Virginia
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUIS A MATOS MD (MEDICAL DIRECTOR)
(434) 252-0026
Entity
Organization
Contact information
Practice address
1019A VISTA PARK DR, FOREST, VA 24551-4901
(434) 515-0419
(844) 693-9305
Mailing address
PO BOX 13103, ROANOKE, VA 24031-3103
(434) 251-0026
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
0101056392
VA
208000000X
Pediatrics Physician
0101056392
VA
2080P0201X
Pediatric Allergy/Immunology Physician
0101056392
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5804426
—
VA
Enumeration date
12/30/2016
Last updated
04/12/2018
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