Wellcare Medical Clinic Inc

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

A46552 Issued in CA

Legal business name

WELLCARE MEDICAL CLINIC INC

Practice address

2990 E Pacific Coast Hwy
Long Beach, CA 90804-1632

Phone

(714) 847-3322

NPI assigned

May 22, 2013

Organization subpart

No

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

Authorized official

Name

Tracy Charles, MD

Title

Officier

Phone

(714) 847-3322

Specialties & licenses 1

Addresses

Tax ID family

Wellcare Medical Clinic Inc2 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.

• Wellcare Medical Clinic. Inc

  • Family Medicine Physician
  • Long Beach, CA
  • NPI 1427488741
  NPD tax ID

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

{
    "created_epoch": "1369180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386028800000",
    "number": "1235575853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2990 E PACIFIC COAST HWY",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908041632",
            "telephone_number": "714-847-3322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2990 E PACIFIC COAST HWY",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908041632",
            "telephone_number": "714-847-3322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLCARE MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-22",
        "last_updated": "2013-12-03",
        "status": "A",
        "authorized_official_last_name": "CHARLES",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "OFFICIER",
        "authorized_official_telephone_number": "714-847-3322",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "CA",
            "license": "A46552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pain Medicine (Anesthesiology) Physician in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Pain Medicine (Anesthesiology) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2013; 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.