1669789319 NPI number — WHEELER WIGGINS, P.A.

Table of content: (NPI 1669789319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669789319 NPI number — WHEELER WIGGINS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHEELER WIGGINS, P.A.
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:
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:
1669789319
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1175 NE 125TH ST
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
NORTH MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33161-5015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-825-5698
Provider Business Mailing Address Fax Number:
305-895-1737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4330 W BROWARD BLVD
Provider Second Line Business Practice Location Address:
SUITE R
Provider Business Practice Location Address City Name:
PLANTATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33317-3775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-825-5698
Provider Business Practice Location Address Fax Number:
305-895-1737
Provider Enumeration Date:
09/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WIGGINS
Authorized Official First Name:
CARTER
Authorized Official Middle Name:
TYRONE
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
305-825-5698

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  80292 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: SW4348 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000109300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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