Provider Demographics
NPI:1356756936
Name:MEDWELL LLC
Entity type:Organization
Organization Name:MEDWELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:EBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-679-7676
Mailing Address - Street 1:610 N GILBERT RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-4502
Mailing Address - Country:US
Mailing Address - Phone:480-926-1111
Mailing Address - Fax:480-926-2958
Practice Address - Street 1:610 N GILBERT RD
Practice Address - Street 2:SUITE 309
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-4502
Practice Address - Country:US
Practice Address - Phone:480-926-1111
Practice Address - Fax:480-926-2958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty