Healthcare Provider Details

I. General information

NPI: 1114985181
Provider Name (Legal Business Name): WELLS MEDICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 05/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S MAIN ST
BLUFFTON IN
46714-2047
US

IV. Provider business mailing address

117 S MAIN ST
BLUFFTON IN
46714-2047
US

V. Phone/Fax

Practice location:
  • Phone: 260-824-9265
  • Fax: 260-824-9267
Mailing address:
  • Phone: 260-824-9265
  • Fax: 260-824-9267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number50004131
License Number StateIN

VIII. Authorized Official

Name: DR. MA LUISA SUMABAT
Title or Position: SECRETARY-TREASURER
Credential: MD
Phone: 260-824-9265