Provider Demographics
NPI:1659587434
Name:WELLSPRING INTERNAL MEDICINE PA
Entity Type:Organization
Organization Name:WELLSPRING INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REINELT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-891-5524
Mailing Address - Street 1:959 MERRIMON AVE BLDG B
Mailing Address - Street 2:STE 202
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-2353
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:959 MERRIMON AVE BLDG B
Practice Address - Street 2:STE 202
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-2353
Practice Address - Country:US
Practice Address - Phone:828-225-6552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC018RMOtherBCBS
NC2347895Medicare PIN