1598700098 NPI number — DR. STEVEN C. WELLER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598700098 NPI number — DR. STEVEN C. WELLER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. STEVEN C. WELLER, 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:
RISING SUN EYE ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1598700098
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
249 WOLAND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELIZABETHVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17023-8665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-362-3014
Provider Business Mailing Address Fax Number:
717-362-4193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
670 RISING SUN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLERSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17061-1245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-692-2122
Provider Business Practice Location Address Fax Number:
717-692-4183
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WELLER
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
717-692-2122

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000385 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 07795176 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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