1821288457 NPI number — WENDELL F. STOELTING OD PC

Table of content: (NPI 1821288457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821288457 NPI number — WENDELL F. STOELTING OD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WENDELL F. STOELTING OD PC
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:
DR. WENDELL F. STOELTING
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:
1821288457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 W. WILLOW ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEROKEE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51012-1856
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-225-3822
Provider Business Mailing Address Fax Number:
712-225-5395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 W WILLOW ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEROKEE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51012-1856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-225-3822
Provider Business Practice Location Address Fax Number:
712-225-5395
Provider Enumeration Date:
07/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STOELTING
Authorized Official First Name:
WENDELL
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
712-225-3822

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1569 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0446377 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CI5976 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com