=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407378755
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELLVIEW, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 810 DOMINICAN DR
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37228-1906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-326-5783
-----------------------------------------------------
Fax | 615-255-4111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 810 DOMINICAN DR
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37228-1906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-326-5783
-----------------------------------------------------
Fax | 615-255-4111
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OPERATING OFFICER
-----------------------------------------------------
Name | MR. LENSIE SCOTT BURLEYSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-326-5783
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305S00000X
-----------------------------------------------------
Taxonomy Name | Point of Service
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------