1194844316 NPI number — LINDA M WIEDE WHCNP

Table of content: LINDA M WIEDE WHCNP (NPI 1194844316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194844316 NPI number — LINDA M WIEDE WHCNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIEDE
Provider First Name:
LINDA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
WHCNP
Provider Gender Code:
F

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:
1194844316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 660599
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75266-0599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5201 HARRY HINES BLVD
Provider Second Line Business Practice Location Address:
WISH TUBAL CLINIC
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75235-7708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-266-0900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2007

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: 363LW0102X , with the licence number:  235931 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 132799106 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132815504 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132815514 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132815515 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132815510 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132815513 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132815509 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132815512 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8Y1698 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 132815511 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132815516 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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