Healthcare Provider Details

I. General information

NPI: 1245291442
Provider Name (Legal Business Name): HEALTHWELL MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

783 N GROVE RD SUITE 108
RICHARDSON TX
75081-6209
US

IV. Provider business mailing address

PO BOX 4847
WICHITA FALLS TX
76308-0847
US

V. Phone/Fax

Practice location:
  • Phone: 972-480-0990
  • Fax: 972-480-8377
Mailing address:
  • Phone: 940-691-6100
  • Fax: 940-691-0757

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 Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number0039904
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0039904
License Number StateTX

VIII. Authorized Official

Name: LARRY DEWAYNE ANDRUS
Title or Position: PRESIDENT
Credential:
Phone: 940-691-6100