Provider Demographics
NPI:1134451081
Name:AMY T WELLS D.P.M.,PA
Entity type:Organization
Organization Name:AMY T WELLS D.P.M.,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:T
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:207-783-7800
Mailing Address - Street 1:PO BOX 1747
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04241-1747
Mailing Address - Country:US
Mailing Address - Phone:207-782-2492
Mailing Address - Fax:207-783-9974
Practice Address - Street 1:675 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5802
Practice Address - Country:US
Practice Address - Phone:207-783-7800
Practice Address - Fax:207-783-7833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD192213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME61309OtherBC
ME407080000Medicaid
ME0031534Medicare PIN