MEDICARE: WELSCARE 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
2	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1831961804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELSCARE LLC

Provider Business Mailing Address
First Line	:	131 E CASCADE AVE
Second Line	:
City	:	ALPINE
State	:	UT
Zip	:	84004-2518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 E 3900 S STE 440
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1349
Country	:	US
Telephone Number	:	801-869-4100
Fax Number	:	801-869-4119

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRAD LILJENQUIST
Credential	:
Telephone Number	:	801-420-2516

Provider Enumeration Date	:	10/24/2023
Last Update Date	:	02/12/2024

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