| Organization Name: | WELLSPRING FAMILY MEDICAL CENTER |
| NPI Number: | 1730304742 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NATHAN L RILES (DOCTOR) |
| Mailing Address: | 648 Independence Pkwy Suite 300 Chesapeake |
| State: | VA US |
| Postal Code: | 233205206 |
| Phone Number: | 7573120166 |
| Fax Number: | 7573128116 |
| NPI Enumeration Date: | 04/16/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 0101044787 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |