Provider Demographics
NPI:1922475151
Name:WELLER HEALTH TRANSITIONS
Entity Type:Organization
Organization Name:WELLER HEALTH TRANSITIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO, CMD
Authorized Official - Phone:937-203-3079
Mailing Address - Street 1:PO BOX 751595
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45475-1595
Mailing Address - Country:US
Mailing Address - Phone:937-203-3079
Mailing Address - Fax:937-886-6609
Practice Address - Street 1:1930 N LAKEMAN DR
Practice Address - Street 2:SUITE 109
Practice Address - City:BELLBROOK
Practice Address - State:OH
Practice Address - Zip Code:45305-1239
Practice Address - Country:US
Practice Address - Phone:937-203-3079
Practice Address - Fax:937-886-6609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0147885Medicaid
H459470Medicare PIN
OH0147885Medicaid