Healthcare Provider Details

I. General information

NPI: 1689665499
Provider Name (Legal Business Name): WELLINGTON IMAGING ASSOCIATES, P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 08/22/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 W SAGAMORE AVE
CLEWISTON FL
33440-3514
US

IV. Provider business mailing address

2715 FRANK ST
EAU CLAIRE WI
54703-2593
US

V. Phone/Fax

Practice location:
  • Phone: 863-902-3000
  • Fax:
Mailing address:
  • Phone: 877-779-0693
  • Fax: 715-834-5870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT D RUEHRMUND
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 561-358-1074