Healthcare Provider Details

I. General information

NPI: 1760617211
Provider Name (Legal Business Name): WELLMAN SLEEP SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 BLUE HERON DR STE 102
MONTGOMERY TX
77316-3192
US

IV. Provider business mailing address

123 BLUE HERON DR STE 102
MONTGOMERY TX
77316-3192
US

V. Phone/Fax

Practice location:
  • Phone: 936-582-1112
  • Fax: 936-582-1151
Mailing address:
  • Phone: 936-582-1112
  • Fax: 936-582-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. CORTNIE RENEE WELLMAN
Title or Position: OWNER
Credential: BS, RPSGT
Phone: 936-828-1919