Provider Demographics
NPI:1114985181
Name:WELLS MEDICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:WELLS MEDICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY-TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MA LUISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMABAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-824-9265
Mailing Address - Street 1:117 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714-2047
Mailing Address - Country:US
Mailing Address - Phone:260-824-9265
Mailing Address - Fax:260-824-9267
Practice Address - Street 1:117 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-2047
Practice Address - Country:US
Practice Address - Phone:260-824-9265
Practice Address - Fax:260-824-9267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50004131261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center