Organization
WELLNESS WARE INC
Active
Other names
Peggy L. Medina dba Wellness Ware
Organization subpart
No
Provider details
NPI number
Authorized official
PEGGY LEE MEDINA (OWNER)
(541) 956-7647
Entity
Organization
Contact information
Practice address
1547 NE F ST, GRANTS PASS, OR 97526-4234
(541) 956-7647
(541) 956-8739
Mailing address
1547 NE F ST, GRANTS PASS, OR 97526-4234
(541) 956-7647
(541) 956-8739
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
247509
—
OR
01
—
820461000
REGENCE BCBS OREGON
OR
01
—
JE-400-01
PACIFIC SOURCE
OR
Enumeration date
01/17/2018
Last updated
01/17/2018
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