Provider Demographics
NPI:1669092169
Name:BE WELL MEDICAL, PLLC
Entity type:Organization
Organization Name:BE WELL MEDICAL, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FNP/OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SKATES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:435-359-0720
Mailing Address - Street 1:41 E 400 N # 322
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4020
Mailing Address - Country:US
Mailing Address - Phone:435-359-0720
Mailing Address - Fax:
Practice Address - Street 1:3935 N 75 W
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:UT
Practice Address - Zip Code:84318-4111
Practice Address - Country:US
Practice Address - Phone:435-359-0720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-24
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1972990828Medicaid
UT1811519085Medicaid