Provider Demographics
NPI:1194744359
Name:WELLSPRING FAMILY MEDICINE, PC
Entity type:Organization
Organization Name:WELLSPRING FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SATURDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-334-7855
Mailing Address - Street 1:311 N 4TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-1395
Mailing Address - Country:US
Mailing Address - Phone:301-334-7855
Mailing Address - Fax:301-334-7828
Practice Address - Street 1:311 N 4TH ST STE 1
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1371
Practice Address - Country:US
Practice Address - Phone:301-334-7855
Practice Address - Fax:833-398-2061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061801207Q00000X, 207V00000X
MDH0064705207Q00000X, 207V00000X
MDC0001983363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001034Medicaid
MD001663200Medicaid
MD002509760Medicaid
MD2128112OtherMAMSI,ALL,OPT CH,MDIPA
MD64303201OtherBCBS MD
MD610547800OtherFEDERAL BLACK LUNG #
MDK076-0001OtherBCBS DC
MD001663200Medicaid
WV3810001034Medicaid
MD001663200Medicaid