Provider Demographics
NPI:1902086879
Name:WELLSPINE,P.A.
Entity Type:Organization
Organization Name:WELLSPINE,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:THOMPSON
Authorized Official - Last Name:WIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-819-9600
Mailing Address - Street 1:8215 WESTCHESTER DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6103
Mailing Address - Country:US
Mailing Address - Phone:214-819-9600
Mailing Address - Fax:214-819-9601
Practice Address - Street 1:12655 N CENTRAL EXPY STE 650
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1770
Practice Address - Country:US
Practice Address - Phone:214-819-9600
Practice Address - Fax:214-819-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6872174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty