Provider Demographics
NPI:1043056260
Name:WELLSPRING WEIGHT & WELLNESS LLC
Entity type:Organization
Organization Name:WELLSPRING WEIGHT & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DNP, FNP-C
Authorized Official - Phone:240-308-1771
Mailing Address - Street 1:555 W OAK ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SHELLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83274-1161
Mailing Address - Country:US
Mailing Address - Phone:986-249-7537
Mailing Address - Fax:
Practice Address - Street 1:555 W OAK ST STE 1
Practice Address - Street 2:
Practice Address - City:SHELLEY
Practice Address - State:ID
Practice Address - Zip Code:83274-1161
Practice Address - Country:US
Practice Address - Phone:986-249-7537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty