LONGEVITY WELLNESS GROUP (NPI# 1538314562) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538314562 |
| Entity Type | Organization |
| Organization Name | LONGEVITY WELLNESS GROUP |
| Other Organization Name | LONGEVITY WELLNESS CENTER |
| Practice Address |
4101 Marathon Boulevard Austin TX 78756-4026 |
| Mailing Address |
Po Box 303460 Austin TX 78703-0058 |
| Practice Telephone | 5123239222 |
| Practice Fax Number | 5123239232 |
| Mailing Telephone | 5123239222 |
| Mailing Fax Number | 5123239232 |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2013-04-15 |
| Authorized Official Name | DR. GREGORY TRENT DAVIS (CEO) |
| Authorized Official Telephone | 5123239222 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 111NI0900X |
Chiropractor Specialization: Internist |
DC30474 | TX | Chiropractic Providers |
| Y | 207R00000X | Internal Medicine | TX | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Longevity Wellness Center | Doing Business As Name - Organization |
| Street Address |
4101 MARATHON BOULEVARD |
| City | AUSTIN |
| State | TX |
| Zip Code | 78756-4026 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053911347 | Sjel Diagnostics of Austin, Pllc | Electrodiagnostic Medicine | 3800 North Lamar Blvd Suite 200, Austin, TX 78756 | 2020-10-27 |
| 1801377874 | Rachel Gabriela Valdez | Counselor | 1508 North Street, Austin, TX 78756 | 2018-08-27 |
| 1225537111 | Lydian Dental Burnet Pllc | Dentist | 5531 Burnet Rd, Austin, TX 78756 | 2018-02-06 |
| 1508306432 | Quinton Dailey | Physical Therapist | 4000 Medical Pkwy Ste 100, Austin, TX 78756 | 2017-02-25 |
| 1316495757 | Nicole Williams Counseling | Clinic/Center | 3906 North Lamar Blvd, Suite 204 D, Austin, TX 78756 | 2016-09-14 |
| 1720431554 | John Graham Reed | Dentist | 4106 Marathon Blvd Ste A, Austin, TX 78756 | 2016-07-17 |
| 1720464779 | Kasey D Kuehler | Counselor | 3709 Medical Parkway, Suite 100, Austin, TX 78756 | 2015-07-31 |
| 1720497126 | Holly Elizabeth Bullion | Nurse Practitioner | 1101 W 40th St # 102, Austin, TX 78756 | 2014-08-11 |
| 1538506233 | Jessica Swanson | Emergency Medicine | 1400 St North I-35, Suite C2.230, Austin, TX 78756 | 2013-06-04 |
| 1740537836 | Austin Regional Home Care Inc. | Home Health | 3810 Medical Parkway, Suite 115, Austin, TX 78756 | 2012-08-08 |
| Find all providers in zip 78756 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750989109 | 3d Regeneration LLC | Internal Medicine | 11610 Bee Caves Rd Ste 230, Austin, TX 78738-5457 | 2020-10-16 |
| 1982210571 | Kim L Rowlands | Internal Medicine | 6101 E Oltorf, None, Austin, TX 78704-7875 | 2020-09-18 |
| 1225644065 | Seton Family of Doctors | Internal Medicine | 3001 Palm Way, D1 : 134-138, Austin, TX 78758 | 2020-09-17 |
| 1528674561 | Knight Doctor Pllc | Internal Medicine | 1401 Eva St Apt 304, Austin, TX 78704-3069 | 2020-09-16 |
| 1306467956 | Jason Russell Paxman | Internal Medicine | Dell Seton Medical Center 1500 Red River, Austin, TX 78701 | 2020-05-05 |
| 1265095160 | Marcos Daniel Villarreal | Internal Medicine | Ut Austin Dell Medical School Seton Internal Medicine, 1500 Red River (dell Seton Medical Center), Austin, TX 78701-1918 | 2019-04-16 |
| 1609368653 | Elain Loquias | Internal Medicine | 1500 Red River St Ste 2.320, Austin, TX 78701 | 2018-06-05 |
| 1851883581 | Suely J Roman Lopez | Internal Medicine | Ut Austin Dell Medical School Internal Medicine, Dell Seaton Medical Center 1500 Red River, Austin, TX 78701 | 2018-05-30 |
| 1265922264 | Devin Leslie | Internal Medicine | Dell Seton Medical Center, 1500 Red River, Austin, TX 78701 | 2018-05-15 |
| 1821585340 | Thrive Physicians Pllc | Internal Medicine | 2217 Park Bend Dr Ste 210, Austin, TX 78758-5674 | 2018-04-19 |
| Find all providers in AUSTIN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.