Provider Demographics
NPI:1821225079
Name:SARA A. WELLS, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SARA A. WELLS, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:PARLEYS MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-474-0355
Mailing Address - Street 1:2131 E 2100 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1128
Mailing Address - Country:US
Mailing Address - Phone:801-474-0355
Mailing Address - Fax:801-485-8007
Practice Address - Street 1:2131 E 2100 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1128
Practice Address - Country:US
Practice Address - Phone:801-474-0355
Practice Address - Fax:801-485-8007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SARA A. WELLS, M.D. A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-15
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT953098541205207Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528395226006Medicaid
UTDP8219OtherRR MEDICARE
UTDP8219OtherRR MEDICARE
UT000066406Medicare PIN
UT000066405Medicare PIN
UTG44977Medicare UPIN