Wellpoint Medical Services, PC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

051736 Issued in GA

Legal business name

WELLPOINT MEDICAL SERVICES, PC

Practice address

1533 Watson Blvd
Ste B
Warner Robins, GA 31093-3449

Phone

(478) 328-6466

Fax

(478) 328-1338

NPI assigned

Oct 28, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Anthony T Securo, M.D.

Title

Medical Director

Phone

(478) 328-6466

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• WellPoint Medical Services, PC Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1414454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419811200000",
    "number": "1114322575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1533 WATSON BLVD",
            "address_2": "SUITE B",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310933449",
            "telephone_number": "478-328-6466",
            "fax_number": "478-328-1338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1533 WATSON BLVD",
            "address_2": "STE B",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310933449",
            "telephone_number": "478-328-6466",
            "fax_number": "478-328-1338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLPOINT MEDICAL SERVICES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-28",
        "last_updated": "2014-12-29",
        "status": "A",
        "authorized_official_last_name": "SECURO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "478-328-6466",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "GA",
            "license": "051736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "051736",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellPoint Medical Services, PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinic/Center in Warner Robins, GA
• Providers in Warner Robins, GA by specialty
• Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.