Provider Demographics
NPI:1447325865
Name:HEALTHWELL INC
Entity type:Organization
Organization Name:HEALTHWELL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:REVEL
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-921-1211
Mailing Address - Street 1:1200 GOUGH ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-6650
Mailing Address - Country:US
Mailing Address - Phone:415-921-1211
Mailing Address - Fax:415-921-1229
Practice Address - Street 1:1200 GOUGH ST
Practice Address - Street 2:SUITE 700
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6650
Practice Address - Country:US
Practice Address - Phone:415-921-1211
Practice Address - Fax:415-921-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT166470Medicare PIN
CAOOPT97810Medicare PIN
CAZZZ28212ZMedicare PIN
CAOPT116420Medicare PIN