Provider Demographics
NPI:1063947398
Name:WELLSPRING MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:WELLSPRING MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:N
Authorized Official - Last Name:ONUH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:615-462-5094
Mailing Address - Street 1:599 SAM RIDLEY PKWY W STE 103
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5646
Mailing Address - Country:US
Mailing Address - Phone:615-462-5094
Mailing Address - Fax:
Practice Address - Street 1:599 SAM RIDLEY PKWY W STE 103
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5646
Practice Address - Country:US
Practice Address - Phone:615-462-5094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDMEHS599332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDMEHS599OtherDMEHS