Provider Demographics
NPI:1487843975
Name:WELLMED MEDICAL GROUP PA
Entity Type:Organization
Organization Name:WELLMED MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OSTEOPATHIC MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:CRABB
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:361-776-5107
Mailing Address - Street 1:225 TERLINGUA
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374
Mailing Address - Country:US
Mailing Address - Phone:361-776-5101
Mailing Address - Fax:361-776-5136
Practice Address - Street 1:2713 MAIN ST
Practice Address - Street 2:
Practice Address - City:INGLESIDE
Practice Address - State:TX
Practice Address - Zip Code:78362
Practice Address - Country:US
Practice Address - Phone:361-776-5107
Practice Address - Fax:361-776-5136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0044261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care