Provider Demographics
NPI:1699705327
Name:WELL SPRING HEALTH CENTER
Entity type:Organization
Organization Name:WELL SPRING HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:BOWERS
Authorized Official - Last Name:SHAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-764-6880
Mailing Address - Street 1:830 MAIN ST
Mailing Address - Street 2:SUITE 20
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2276
Mailing Address - Country:US
Mailing Address - Phone:207-764-6880
Mailing Address - Fax:207-764-0427
Practice Address - Street 1:830 MAIN ST
Practice Address - Street 2:SUITE 20
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2276
Practice Address - Country:US
Practice Address - Phone:207-764-6880
Practice Address - Fax:207-764-0427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1607204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME022895OtherANTHEM BCBS
ME410380000Medicaid
ME410380000Medicaid