Healthcare Provider Details

I. General information

NPI: 1255968996
Provider Name (Legal Business Name): WELLMED TESTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 NE LYNNWOOD LOOP
BELFAIR WA
98528-9489
US

IV. Provider business mailing address

PO BOX 1731
BELFAIR WA
98528-1731
US

V. Phone/Fax

Practice location:
  • Phone: 360-275-2892
  • Fax:
Mailing address:
  • Phone: 360-275-2892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: LINDA CLARK
Title or Position: MEMBER
Credential:
Phone: 360-275-2892