Provider Demographics
NPI:1295064319
Name:WELLMARK INC
Entity type:Organization
Organization Name:WELLMARK INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:949-466-6199
Mailing Address - Street 1:2820 W CHARLESTON BLVD STE 37
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1934
Mailing Address - Country:US
Mailing Address - Phone:702-880-7525
Mailing Address - Fax:702-880-7055
Practice Address - Street 1:2820 W CHARLESTON BLVD STE 37
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1934
Practice Address - Country:US
Practice Address - Phone:702-880-7525
Practice Address - Fax:702-880-7055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-19
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health