Provider Demographics
NPI:1609893445
Name:WELLSPOT, INC
Entity Type:Organization
Organization Name:WELLSPOT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KAJDOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-988-9577
Mailing Address - Street 1:2125 DATA OFFICE DR.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244
Mailing Address - Country:US
Mailing Address - Phone:205-988-9577
Mailing Address - Fax:205-985-8891
Practice Address - Street 1:335 SUMMIT BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243
Practice Address - Country:US
Practice Address - Phone:205-969-3608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-022229363LF0000X
SCAPN1171363LF0000X
AL1-097558363LF0000X
AL1-055956363LF0000X
SCAPN1282363LF0000X
SCAPRN11363LF0000X
AL1-098736363LF0000X
AL1-053893363LF0000X
AL1-036797363LF0000X
AL1-040024363LF0000X
AL1-037793363LF0000X
AL1-094910363LF0000X
AL1-095779363LF0000X
AL1-061723363LF0000X
AL1-055040363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS88815Medicare UPIN
SCR55269Medicare UPIN
ALP17903Medicare UPIN
ALQ00068Medicare UPIN
ALQ46877Medicare UPIN
ALP46922Medicare UPIN
ALS75413Medicare UPIN
ALQ17105Medicare UPIN
ALP77555Medicare UPIN
SCR96038Medicare UPIN