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General NPI Number Information
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NPI Number | 1174863872
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Entity Type | Organization
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Legal Business Name | WELLS SURGICAL SERVICES, LLC
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Dates
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Enumeration Date | 02/18/2013
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Last Update Date | 02/18/2013
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Provider Practice Location Address
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Address Line | 1201 MONUMENT RD SUITE 201B
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City | JACKSONVILLE
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State | FL
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Zip | 32225-7411
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Country | US
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Telephone | 904-281-5878
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Fax | 904-724-9234
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Provider Business Mailing Address
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Address Line | 1201 MONUMENT RD SUITE 201B
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City | JACKSONVILLE
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State | FL
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Zip | 32225-7411
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Country | US
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Telephone | 904-281-5878
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Fax | 904-724-9234
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Authorized Official
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Title or Position | PRESIDENT
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Name | CAROL PATRICIA BOWEN-WELLS
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Credential | M.D.
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Telephone | 904-281-5878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME104932
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License Number State | FL
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