Provider Demographics
NPI:1285439570
Name:WELLCARE MEDICAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:WELLCARE MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GONFA
Authorized Official - Middle Name:HORDOFA
Authorized Official - Last Name:GUTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-705-0421
Mailing Address - Street 1:7213 LINDA TRCE
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-9411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7213 LINDA TRCE
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-9411
Practice Address - Country:US
Practice Address - Phone:240-705-0421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)