Provider Demographics
NPI:1235373309
Name:WELLS ALLERGY AND PEDIATRIC ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:WELLS ALLERGY AND PEDIATRIC ASSOCIATES, PLLC
Other - Org Name:WELLS ALLERGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-452-3300
Mailing Address - Street 1:12806 GLORYWHITE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-3685
Mailing Address - Country:US
Mailing Address - Phone:713-301-0159
Mailing Address - Fax:281-922-6448
Practice Address - Street 1:5618 E SAM HOUSTON PKWY N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-3249
Practice Address - Country:US
Practice Address - Phone:281-452-3300
Practice Address - Fax:281-452-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6949261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201388001Medicaid