Provider Demographics
NPI:1932666344
Name:WELLSPAN MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:WELLSPAN MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:REPAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-643-7888
Mailing Address - Street 1:599 9TH ST N STE 211
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5625
Mailing Address - Country:US
Mailing Address - Phone:239-643-7888
Mailing Address - Fax:239-643-4744
Practice Address - Street 1:599 9TH ST N STE 211
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5625
Practice Address - Country:US
Practice Address - Phone:239-643-7888
Practice Address - Fax:239-643-4744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty