| Wellstone Regional Hospital Acquisition Llc | |
|
2700 Vissing Park Rd Jeffersonville IN 47130-5943 | |
| (812) 284-8000 | |
| (812) 258-2023 |
| Full Name | Wellstone Regional Hospital Acquisition Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2700 Vissing Park Rd, Jeffersonville, Indiana |
| Authorized Official Name and Position | Dean Saling (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2182581044 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellstone Regional Hospital Acquisition Llc 2700 Vissing Park Rd Jeffersonville IN 47130-5943 Ph: (812) 284-8000 | Wellstone Regional Hospital Acquisition Llc 2700 Vissing Park Rd Jeffersonville IN 47130-5943 Ph: (812) 284-8000 |
| NPI Number | 1194864843 |
|---|---|
| Provider Enumeration Date | 02/06/2007 |
| Last Update Date | 05/27/2008 |
| Medicare PECOS PAC ID | 3577585066 |
|---|---|
| Medicare Enrollment ID | O20070608000026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194864843 | NPI | - | NPPES |
| 200820740 | Medicaid | IN | |
| 65945685 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Asad Ismail |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144227026 PECOS PAC ID: 7214926195 Enrollment ID: I20040506001422 |
| Provider Name | Eric Lydon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609873579 PECOS PAC ID: 3072406669 Enrollment ID: I20050307000489 |
| Provider Name | Mohammad A Mian |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881796183 PECOS PAC ID: 4789621681 Enrollment ID: I20050412001258 |
| Provider Name | Ross E Nunes |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366588824 PECOS PAC ID: 7315192424 Enrollment ID: I20130221000081 |
| Provider Name | Sufian Ahmad |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821352824 PECOS PAC ID: 0244529873 Enrollment ID: I20210226002175 |
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