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NPI Code Detail

MEDICARE: ROGER D WELLS PA-C

MEDICARE: ROGER D WELLS PA-C
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
1363A00000XPhysician Assistant376NE

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
170005753OTHERNERAILROAD MEDICARE

General Provider Information

NPI Number : 1508842469
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGER D WELLS PA-C
Provider Business Mailing Address
First Line : PO BOX 980
Second Line :
City : LEXINGTON
State : NE
Zip : 68850-0980
Country : US
Telephone Number : 308-324-5651
Fax Number :
Provider Business Practice Location Address
First Line : 1201 N ERIE ST
Second Line :
City : LEXINGTON
State : NE
Zip : 68850-1571
Country : US
Telephone Number : 308-324-5651
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2005
Last Update Date : 08/28/2019

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Directions to “ ROGER D WELLS PA-C” Practice Location

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