Provider Demographics
NPI:1902004799
Name:WELL SPRING CANCER CENTER L.L.C.
Entity Type:Organization
Organization Name:WELL SPRING CANCER CENTER L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-409-1349
Mailing Address - Street 1:6449 38TH AVE N
Mailing Address - Street 2:SUITE C-3
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1655
Mailing Address - Country:US
Mailing Address - Phone:727-384-3735
Mailing Address - Fax:727-345-5352
Practice Address - Street 1:6449 38TH AVE N
Practice Address - Street 2:SUITE C-3
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1655
Practice Address - Country:US
Practice Address - Phone:727-384-3735
Practice Address - Fax:727-345-5352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty