Provider Demographics
NPI:1316390768
Name:WELLLIFE LABS LLC
Entity Type:Organization
Organization Name:WELLLIFE LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-970-5900
Mailing Address - Street 1:9777 W GULF BANK RD
Mailing Address - Street 2:STE 5
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-3132
Mailing Address - Country:US
Mailing Address - Phone:281-970-5900
Mailing Address - Fax:
Practice Address - Street 1:19073 I 45 S STE 145
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-8744
Practice Address - Country:US
Practice Address - Phone:281-970-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory