MEDICARE: WELLNESS WARE 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
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	820461000	OTHER	OR	REGENCE BCBS OREGON
3	JE-400-01	OTHER	OR	PACIFIC SOURCE

General Provider Information

NPI Number	:	1952819591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS WARE INC

Provider Business Mailing Address
First Line	:	1547 NE F ST
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-4234
Country	:	US
Telephone Number	:	541-956-7647
Fax Number	:	541-956-8739

Provider Business Practice Location Address
First Line	:	1547 NE F ST
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-4234
Country	:	US
Telephone Number	:	541-956-7647
Fax Number	:	541-956-8739

Authorized Official
Title or Position	:	OWNER
Name	:	PEGGY LEE MEDINA
Credential	:
Telephone Number	:	541-956-7647

Provider Enumeration Date	:	01/17/2018
Last Update Date	:	01/17/2018

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Directions to “WELLNESS WARE INC ” Practice Location

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