Provider Demographics
NPI:1134309511
Name:WELLS FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:WELLS FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCT. MNGR.
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-854-1544
Mailing Address - Street 1:PO BOX 1089
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-1089
Mailing Address - Country:US
Mailing Address - Phone:207-646-0676
Mailing Address - Fax:
Practice Address - Street 1:59 MILE ROAD
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090
Practice Address - Country:US
Practice Address - Phone:207-646-0676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM312301OtherSAM'S PTAN
ME1467544668OtherJEFFS IND NPI
ME1336231539OtherSAM'S IND NPI
ME1457434573OtherCHRIS'S IND NPI
MEMM941201OtherJEFF'S PTAN
ME1336231539OtherSAM'S IND NPI