Provider Demographics
NPI:1245291442
Name:HEALTHWELL MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:HEALTHWELL MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:ANDRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-691-6100
Mailing Address - Street 1:PO BOX 4847
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-0847
Mailing Address - Country:US
Mailing Address - Phone:940-691-6100
Mailing Address - Fax:940-691-0757
Practice Address - Street 1:783 N GROVE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-6209
Practice Address - Country:US
Practice Address - Phone:972-480-0990
Practice Address - Fax:972-480-8377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0039904332BP3500X, 332BX2000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011150201Medicaid
TX017206601Medicaid
TX011150201Medicaid