Organization
MEDIWELL, INC.
Active
Other names
Mediwell Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAVDEEP SINGH BHASIN (CEO)
(916) 458-9355
Entity
Organization
Contact information
Practice address
1733 CREEKSIDE DR, FOLSOM, CA 95630-3457
(916) 458-9355
(916) 458-9353
Mailing address
1733 CREEKSIDE DR, FOLSOM, CA 95630-3457
(916) 458-9355
(916) 458-9353
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
A055920
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0095610
—
CA
01
—
ZZZ28024Z
MEDICARE GROUP NUMBER
CA
Enumeration date
10/16/2006
Last updated
09/08/2008
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