1376781765 NPI number — W MAIER INC

Table of content: (NPI 1376781765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376781765 NPI number — W MAIER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
W MAIER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WALTER M. MAIER M.D.
Provider Other Organization Name Type Code:
5
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:
1376781765
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1141
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR GLEN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92321-1141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-337-3661
Provider Business Mailing Address Fax Number:
909-337-3570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29099 HOSPITAL ROAD
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
LAKE ARROWHEAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-337-3661
Provider Business Practice Location Address Fax Number:
909-337-3570
Provider Enumeration Date:
01/23/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAIER
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
MARKUS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-337-3661

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  G82114 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083P0500X , with the licence number: G082114 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2083P0901X , with the licence number: G82114 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: G82114 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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