Healthcare Provider Details

I. General information

NPI: 1134826589
Provider Name (Legal Business Name): WELL MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N GOULD ST STE 32677
SHERIDAN WY
82801-6317
US

IV. Provider business mailing address

30 N GOULD ST STE 32677
SHERIDAN WY
82801-6317
US

V. Phone/Fax

Practice location:
  • Phone: 307-381-1405
  • Fax:
Mailing address:
  • Phone: 307-381-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MOHAMED ELARBI
Title or Position: CEO/ PRESIDENT
Credential:
Phone: 786-694-7346