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NPI Code Detail

MEDICARE: WELLFAST HEALTH INC

MEDICARE: WELLFAST HEALTH INC
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
1261QU0200XUrgent Care Clinic/CenterTX
2207Q00000XFamily Medicine PhysicianH5430TX

General Provider Information

NPI Number : 1528451366
Entity Type Code : Organization
Provider Name (Legal Business Name) : WELLFAST HEALTH INC
Provider Business Mailing Address
First Line : 1509 S HIGHWAY 69
Second Line :
City : NEDERLAND
State : TX
Zip : 77627-7807
Country : US
Telephone Number : 409-722-9355
Fax Number : 409-420-1002
Provider Business Practice Location Address
First Line : 1509 S HIGHWAY 69
Second Line :
City : NEDERLAND
State : TX
Zip : 77627-7807
Country : US
Telephone Number : 409-722-9355
Fax Number : 409-420-1002
Authorized Official
Title or Position : OWNER/ PRACTICE MANAGER
Name : BEN JOHNSON
Credential :
Telephone Number : 409-722-9355
Provider Enumeration Date : 03/17/2015
Last Update Date : 04/22/2015

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Directions to “WELLFAST HEALTH INC ” Practice Location

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