Healthcare Provider Details

I. General information

NPI: 1437457710
Provider Name (Legal Business Name): WELLMED MEDICAL GROUP, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 W BEN WHITE BLVD SUITE 100
AUSTIN TX
78704-7034
US

IV. Provider business mailing address

8637 FREDERICKSBURG ROAD, SUITE 360 ATTN: DIRECTOR OF ACCOUNTS RECEIVABLE
SAN ANTONIO TX
78240-1285
US

V. Phone/Fax

Practice location:
  • Phone: 512-442-1996
  • Fax: 512-442-1093
Mailing address:
  • Phone: 210-877-7570
  • Fax: 210-641-2235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CARLOS O HERNANDEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 210-877-7570