MEDICARE: WELLSHOD, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies	1004	TX

General Provider Information

NPI Number	:	1184889198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSHOD, LLC

Provider Business Mailing Address
First Line	:	7500 N MESA ST
Second Line	:	SUITE 105
City	:	EL PASO
State	:	TX
Zip	:	79912-3501
Country	:	US
Telephone Number	:	915-587-0707
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 N MESA ST
Second Line	:	SUITE 105
City	:	EL PASO
State	:	TX
Zip	:	79912-3501
Country	:	US
Telephone Number	:	915-587-0707
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HSIAO-CH'UN YU
Credential	:	DPM
Telephone Number	:	575-644-9356

Provider Enumeration Date	:	07/20/2008
Last Update Date	:	07/20/2008

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