Provider Demographics
NPI:1134305519
Name:WELLSPRING MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:WELLSPRING MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-421-0955
Mailing Address - Street 1:1105 N GENERAL BRUCE DR
Mailing Address - Street 2:SUITE-2
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-2468
Mailing Address - Country:US
Mailing Address - Phone:254-421-0955
Mailing Address - Fax:
Practice Address - Street 1:1105 N GENERAL BRUCE DR
Practice Address - Street 2:SUITE-2
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-2468
Practice Address - Country:US
Practice Address - Phone:254-421-0955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies