Healthcare Provider Details

I. General information

NPI: 1679497903
Provider Name (Legal Business Name): MAVERICK WELLS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2947 SIX MILE LN
LOUISVILLE KY
40220-3406
US

IV. Provider business mailing address

2947 SIX MILE LN
LOUISVILLE KY
40220-3406
US

V. Phone/Fax

Practice location:
  • Phone: 830-200-2866
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL

VIII. Authorized Official

Name: ISMAIL MAHEBUB PATEL
Title or Position: OWNER
Credential:
Phone: 830-200-2877