Provider Demographics
NPI:1780608315
Name:KAISER WELLS INC
Entity type:Organization
Organization Name:KAISER WELLS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NESTOR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:419-668-7651
Mailing Address - Street 1:251 BENEDICT AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2346
Mailing Address - Country:US
Mailing Address - Phone:419-668-7651
Mailing Address - Fax:419-663-5837
Practice Address - Street 1:251 BENEDICT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2346
Practice Address - Country:US
Practice Address - Phone:419-668-7651
Practice Address - Fax:419-663-5837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHMER.22043332B00000X
OH3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03501OtherPARAMOUNT HEALTHCARE
OH4511335Medicaid
OH56129OtherABP
OH56129OtherNORTHWOOD NPN
000000155940OtherUNICARE
OH000000155940OtherANTHEM BCBS
OH4511335OtherBCMH
OH4511335OtherBCMH
OH4511335Medicaid