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NPI Code Detail

MEDICARE: DR. JACK CODY WELLS JR. M.D.

MEDICARE: DR. JACK CODY WELLS JR. M.D.
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
1207P00000XEmergency Medicine PhysicianR4G70MO
2207Q00000XFamily Medicine PhysicianR4G70MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629042882
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACK CODY WELLS JR. M.D.
Provider Business Mailing Address
First Line : PO BOX 843966
Second Line :
City : KANSAS CITY
State : MO
Zip : 64184-3966
Country : US
Telephone Number : 573-884-3300
Fax Number : 573-884-0943
Provider Business Practice Location Address
First Line : 551 VETERANS UNITED DR
Second Line :
City : COLUMBIA
State : MO
Zip : 65201-8397
Country : US
Telephone Number : 573-884-7733
Fax Number : 573-882-6228
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2006
Last Update Date : 08/15/2024

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