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General NPI Number Information
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NPI Number | 1447501184
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Entity Type | Organization
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Legal Business Name | PENNYRILE GENERAL & WEIGHT LOSS SURGERY PLLC
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Dates
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Enumeration Date | 09/20/2012
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Last Update Date | 04/11/2014
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Provider Practice Location Address
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Address Line | 320 W 18TH ST
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-1965
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Country | US
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Telephone | 270-632-4555
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Fax | 270-632-4556
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Provider Business Mailing Address
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Address Line | PO BOX 2400
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City | HOPKINSVILLE
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State | KY
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Zip | 42241-2400
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Country | US
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Telephone | 270-632-4555
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Fax | 270-632-4556
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | GERAME T WELLS
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Credential | MD
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Telephone | 270-887-0278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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