MEDICARE: WELLSPRING MEDICAL SUPPLY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)

General Provider Information

NPI Number	:	1134305519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSPRING MEDICAL SUPPLY INC.

Provider Business Mailing Address
First Line	:	1105 N GENERAL BRUCE DR
Second Line	:	SUITE-2
City	:	TEMPLE
State	:	TX
Zip	:	76504-2468
Country	:	US
Telephone Number	:	254-421-0955
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 N GENERAL BRUCE DR
Second Line	:	SUITE-2
City	:	TEMPLE
State	:	TX
Zip	:	76504-2468
Country	:	US
Telephone Number	:	254-421-0955
Fax Number	:

Authorized Official
Title or Position	:	OWER/ADMINISTRATOR
Name	:	FRANK LEE GORDON
Credential	:
Telephone Number	:	254-421-0955

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	01/15/2008

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