Provider Demographics
NPI:1104515402
Name:WELLSTART MEDICAL, LLC
Entity type:Organization
Organization Name:WELLSTART MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-978-7599
Mailing Address - Street 1:9156 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-3490
Mailing Address - Country:US
Mailing Address - Phone:800-978-7599
Mailing Address - Fax:800-971-3199
Practice Address - Street 1:1745 S ALMA SCHOOL RD STE 210
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3012
Practice Address - Country:US
Practice Address - Phone:800-978-7599
Practice Address - Fax:800-971-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies