Provider Demographics
NPI:1174863872
Name:WELLS SURGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:WELLS SURGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:BOWEN-WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-281-5878
Mailing Address - Street 1:1201 MONUMENT RD
Mailing Address - Street 2:SUITE 201B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-7411
Mailing Address - Country:US
Mailing Address - Phone:904-281-5878
Mailing Address - Fax:904-724-9234
Practice Address - Street 1:1201 MONUMENT RD
Practice Address - Street 2:SUITE 201B
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-7411
Practice Address - Country:US
Practice Address - Phone:904-281-5878
Practice Address - Fax:904-724-9234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104932208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty