Healthcare Provider Details

I. General information

NPI: 1255295903
Provider Name (Legal Business Name): ALLWELL MEDICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 BONITA DR
PENSACOLA FL
32507-8163
US

IV. Provider business mailing address

1068 BONITA DR
PENSACOLA FL
32507-8163
US

V. Phone/Fax

Practice location:
  • Phone: 65-131-8202
  • Fax: 65-131-8202
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: CLIFFORD TULLY
Title or Position: PRESIDENT
Credential:
Phone: 651-318-2025