Organization
EUREKA DIAGNOSTIC IMAGING PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK WELLENS MD (PRESIDENT)
(802) 885-7320
Entity
Organization
Contact information
Practice address
25 RIDGEWOOD RD, SPRINGFIELD, VT 05156-3050
(802) 885-7320
Mailing address
PO BOX 910, GREENFIELD, MA 01302-0910
(413) 772-8500
(413) 772-8900
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005920
—
VT
05
—
81305920
—
NH
01
—
EURE00005920
BC/BS VT
VT
Enumeration date
06/10/2006
Last updated
08/22/2020
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