1184716144 NPI number — DR. ROBERT VERNE WIGGINS

Table of content: DR. ROBERT VERNE WIGGINS (NPI 1184716144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184716144 NPI number — DR. ROBERT VERNE WIGGINS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIGGINS
Provider First Name:
ROBERT
Provider Middle Name:
VERNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184716144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 SE BISHOP BLVD
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
PULLMAN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99163-5517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-334-5876
Provider Business Mailing Address Fax Number:
509-332-8793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 SE BISHOP BLVD
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
PULLMAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99163-5517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-334-5876
Provider Business Practice Location Address Fax Number:
509-332-8793
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207YX0007X , with the licence number:  MD00025460 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 911408453 . This is a "PREMERA BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003289500 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: DEHV6 . This is a "BLUE CROSS OF ID" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 0007539 . This is a "LABOR AND INDUSTRIES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1046598 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 911408453 . This is a "GROUP HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 911408453 . This is a "MOLINA HEALTHCARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8912267 . This is a "CVCP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 000010004066 . This is a "BLUE SHIELD OF ID" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 911408453 . This is a "FIRST CHOICE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 911408453 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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