Provider Demographics
NPI:1578918116
Name:WELLCAREAMERICA LLC
Entity type:Organization
Organization Name:WELLCAREAMERICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-318-1349
Mailing Address - Street 1:11220 ELM LN STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0450
Mailing Address - Country:US
Mailing Address - Phone:877-318-1349
Mailing Address - Fax:919-354-2936
Practice Address - Street 1:11220 ELM LN STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-0450
Practice Address - Country:US
Practice Address - Phone:877-318-1349
Practice Address - Fax:919-354-2936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography