Provider Demographics
NPI:1356617062
Name:WELLSPRING FAMILY MEDICINE
Entity type:Organization
Organization Name:WELLSPRING FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:REIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-474-5800
Mailing Address - Street 1:1171 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1303
Mailing Address - Country:US
Mailing Address - Phone:740-474-5800
Mailing Address - Fax:740-474-3212
Practice Address - Street 1:1171 N COURT ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1303
Practice Address - Country:US
Practice Address - Phone:740-474-5800
Practice Address - Fax:740-474-3212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care