MEDICARE: ALLWELL MEDICAL SUPPLIES 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	2086X0206X	Surgical Oncology Physician

General Provider Information

NPI Number	:	1255295903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLWELL MEDICAL SUPPLIES LLC

Provider Business Mailing Address
First Line	:	1068 BONITA DR
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32507-8163
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1068 BONITA DR
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32507-8163
Country	:	US
Telephone Number	:	65-131-8202
Fax Number	:	65-131-8202

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CLIFFORD TULLY
Credential	:
Telephone Number	:	651-318-2025

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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