Provider Demographics
NPI:1558445833
Name:WELLMEDICINE PLLC
Entity Type:Organization
Organization Name:WELLMEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. NGUYEN/INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MINH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-579-1319
Mailing Address - Street 1:1502 E. RED RIVER PMB 338
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5523
Mailing Address - Country:US
Mailing Address - Phone:361-579-1319
Mailing Address - Fax:361-579-1317
Practice Address - Street 1:2710 HOSPITAL DR
Practice Address - Street 2:SUITE 108
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901
Practice Address - Country:US
Practice Address - Phone:361-579-1319
Practice Address - Fax:361-579-1317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4757207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173838701Medicaid
TX173838701Medicaid
TXG77918Medicare UPIN
TX173838701Medicaid