Provider Demographics
NPI:1821009747
Name:WELLSPRING HEALTHCARE, PLLC
Entity Type:Organization
Organization Name:WELLSPRING HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-283-0333
Mailing Address - Street 1:403 PRINCETON RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2056
Mailing Address - Country:US
Mailing Address - Phone:423-283-0333
Mailing Address - Fax:423-283-0518
Practice Address - Street 1:403 PRINCETON RD
Practice Address - Street 2:SUITE 7
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2056
Practice Address - Country:US
Practice Address - Phone:423-283-0333
Practice Address - Fax:423-283-0518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN371182Medicaid
TN371182Medicaid