Provider Demographics
NPI:1407541022
Name:WELLFORD MEDICINE, LLC
Entity Type:Organization
Organization Name:WELLFORD MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRAS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:864-439-5338
Mailing Address - Street 1:102 ASTOR ST
Mailing Address - Street 2:
Mailing Address - City:WELLFORD
Mailing Address - State:SC
Mailing Address - Zip Code:29385-9622
Mailing Address - Country:US
Mailing Address - Phone:864-439-5338
Mailing Address - Fax:864-439-4769
Practice Address - Street 1:102 ASTOR ST
Practice Address - Street 2:
Practice Address - City:WELLFORD
Practice Address - State:SC
Practice Address - Zip Code:29385-9622
Practice Address - Country:US
Practice Address - Phone:864-439-5338
Practice Address - Fax:864-439-4769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty