1952625808 NPI number — MY WELL CARE

Table of content: (NPI 1952625808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952625808 NPI number — MY WELL CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MY WELL CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952625808
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 58793
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37205-8793
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-833-6898
Provider Business Mailing Address Fax Number:
615-833-6895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2275 MURFREESBORO PIKE
Provider Second Line Business Practice Location Address:
STE 109 & 110
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37217-3341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-833-6898
Provider Business Practice Location Address Fax Number:
615-833-6895
Provider Enumeration Date:
03/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ARTHUR
Authorized Official First Name:
CLARISSA
Authorized Official Middle Name:
NELSON
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
615-833-6898

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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