Provider Demographics
NPI:1588733661
Name:WELLSPRINGS INSTITUTE, PLLC
Entity type:Organization
Organization Name:WELLSPRINGS INSTITUTE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-554-7546
Mailing Address - Street 1:2721 W PARK DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-9058
Mailing Address - Country:US
Mailing Address - Phone:270-554-7546
Mailing Address - Fax:270-554-0316
Practice Address - Street 1:2721 W PARK DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-9058
Practice Address - Country:US
Practice Address - Phone:270-554-7546
Practice Address - Fax:270-554-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7958Medicare ID - Type UnspecifiedMEDICARE