Provider Demographics
NPI:1164138624
Name:WELLCARE MEDICAL LLC
Entity Type:Organization
Organization Name:WELLCARE MEDICAL LLC
Other - Org Name:WELLCARE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZUNKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-780-0100
Mailing Address - Street 1:8400 CORAL SEA STREET NE
Mailing Address - Street 2:STE 200
Mailing Address - City:MOUNDS VIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55112
Mailing Address - Country:US
Mailing Address - Phone:763-780-0100
Mailing Address - Fax:763-780-0420
Practice Address - Street 1:8400 CORAL SEA STREET NE
Practice Address - Street 2:STE 200
Practice Address - City:MOUNDS VIEW
Practice Address - State:MN
Practice Address - Zip Code:55112
Practice Address - Country:US
Practice Address - Phone:763-780-0100
Practice Address - Fax:763-780-0420
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONSOLIDATED HEALTHCARE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-27
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies