Healthcare Provider Details

I. General information

NPI: 1770367468
Provider Name (Legal Business Name): WELLTRACKONE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 OFFICE PARK RD STE 213
HILTON HEAD ISLAND SC
29928-4640
US

IV. Provider business mailing address

32 OFFICE PARK RD STE 213
HILTON HEAD ISLAND SC
29928-4640
US

V. Phone/Fax

Practice location:
  • Phone: 843-341-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WENDY A BYRNE
Title or Position: PAYER ENROLLMENT MANAGER
Credential:
Phone: 951-503-1430