MEDICARE: ALL WELL MEDICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1235890856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL WELL MEDICAL LLC

Provider Business Mailing Address
First Line	:	4303 VINELAND RD STE F9
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-7372
Country	:	US
Telephone Number	:	321-209-8676
Fax Number	:	512-532-0923

Provider Business Practice Location Address
First Line	:	4303 VINELAND RD STE F9
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-7372
Country	:	US
Telephone Number	:	321-209-8676
Fax Number	:	512-532-0923

Authorized Official
Title or Position	:	BILLER
Name	:	TYLER PENROD
Credential	:
Telephone Number	:	305-900-4715

Provider Enumeration Date	:	01/05/2022
Last Update Date	:	01/05/2022

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