NPIMap

Organization Active NPI

Wellspring Clinic LLC

  • Medical Specialty Clinic/Center
  • Bel Air, MD
National Provider Identifier
1154788818
Registry record updated Jul 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
D63924 Issued in MD
Legal business name
WELLSPRING CLINIC LLC
Practice address
2012 S Tollgate Rd Ste 207
Bel Air, MD 21015-5902
Phone
(443) 371-9750
NPI assigned
Jan 26, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2019

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

Authorized official

Name
Nkiruka Arene, MDNPI 1477517332
Title
Owner
Phone
(443) 977-9180

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X D63924 MD Primary

Addresses

Primary practice location

2012 S Tollgate Rd Ste 207
Bel Air, MD 21015-5902

Mailing address

2012 S Tollgate Rd
Suite 206
Bel Air, MD 21015-5900
Phone (443) 977-9180

National Provider Directory

National Provider Directory
Tax ID family
Wellspring Clinic LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1453766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562889600000",
    "number": "1154788818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2012 S TOLLGATE RD",
            "address_2": "SUITE 206",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210155900",
            "telephone_number": "443-977-9180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2012 S TOLLGATE RD STE 207",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210155902",
            "telephone_number": "443-371-9750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPRING CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-26",
        "last_updated": "2019-07-12",
        "status": "A",
        "authorized_official_last_name": "ARENE",
        "authorized_official_first_name": "NKIRUKA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-977-9180",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MD",
            "license": "D63924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bel Air, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2019; 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.