Provider Demographics
NPI:1366030173
Name:WELLSPECT INC
Entity Type:Organization
Organization Name:WELLSPECT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-341-9291
Mailing Address - Street 1:1235 FRIENDSHIP RD STE 205
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-5626
Mailing Address - Country:US
Mailing Address - Phone:877-356-3742
Mailing Address - Fax:
Practice Address - Street 1:125 W ROMANA ST STE 210
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-5848
Practice Address - Country:US
Practice Address - Phone:877-456-3742
Practice Address - Fax:866-666-6250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies