Provider Demographics
NPI:1184894396
Name:RAYMOND D. WELLS PSC
Entity type:Organization
Organization Name:RAYMOND D. WELLS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-298-3412
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:INEZ
Mailing Address - State:KY
Mailing Address - Zip Code:41224
Mailing Address - Country:US
Mailing Address - Phone:606-298-3412
Mailing Address - Fax:606-298-7002
Practice Address - Street 1:62 ROCKCASTLE RD
Practice Address - Street 2:
Practice Address - City:INEZ
Practice Address - State:KY
Practice Address - Zip Code:41224-1088
Practice Address - Country:US
Practice Address - Phone:606-298-3412
Practice Address - Fax:606-298-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14210261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64142102Medicaid
KY64142102Medicaid