Provider Demographics
NPI:1700973922
Name:WELLSTON MEDICAL CENTER PLLC
Entity type:Organization
Organization Name:WELLSTON MEDICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WARNSHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-655-0095
Mailing Address - Street 1:14477 CABERFAE HWY
Mailing Address - Street 2:
Mailing Address - City:WELLSTON
Mailing Address - State:MI
Mailing Address - Zip Code:49689-9315
Mailing Address - Country:US
Mailing Address - Phone:231-655-0095
Mailing Address - Fax:
Practice Address - Street 1:14477 CABERFAE HWY
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:MI
Practice Address - Zip Code:49689-9315
Practice Address - Country:US
Practice Address - Phone:231-848-4777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-08
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
233919Medicare Oscar/Certification