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General NPI Number Information
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NPI Number | 1477710804
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Entity Type | Organization
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Legal Business Name | WELLCARE OF TEXAS, INC.
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 05/05/2016
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Provider Practice Location Address
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Address Line | 11200 RICHMOND AVE SUITE 450
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City | HOUSTON
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State | TX
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Zip | 77082
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Country | US
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Telephone | 713-630-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 8735 HENDERSON RD
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City | TAMPA
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State | FL
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Zip | 33634-1143
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Country | US
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Telephone | 813-290-6200
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Fax |
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Authorized Official
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Title or Position | VP & SECRETARY
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Name | MICHAEL HABER
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Credential |
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Telephone | 813-206-1490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 14352
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License Number State | TX
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