Roy Wells Jr., PAC
Individual provider Active NPI Physician Assistant · Swanton, VT
NPI 1215939079 · NPPES record last updated Oct 15, 2007
Key facts
- NPI
- 1215939079
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 0550030649 (VT)
- Practice address
- 45 Church St
Swanton, VT 05488-1434 - Phone
- (802) 868-2454
- Fax
- (802) 868-2461
- NPI assigned
- Aug 11, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0550030649 | VT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwestern Medical Center, Inc | Past | Accepting new patients | |
| Clearchoicemd Primary Care PLLC | Past | Accepting new patients | |
| The Richford Health Center Inc | Past | Accepting new patients | |
| The Richford Health Center Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0550030649 | VT | Yes |
Addresses
Primary practice location
45 Church St
Swanton, VT 05488-1434
Mailing address
PO Box 235
Fairfax, VT 05454-0235
Phone (802) 868-2454
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0002358 | Medicaid | VT | |
| 00049928 | Other | VT | BCBS |
Other providers in Swanton, VT
- The Richford Health Center Inc
- The Richford Health Center Inc
- The Richford Health Center, Inc.
- Tiffany Elizabeth Trombley
- Kristina Myrtis Unikewicz
- Lawrence Hawfield White
- Amanda L Wilson
- Robert Zelazo
All providers in Swanton, VT · Physician Assistant in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.