1861483265 NPI number — DR. WAYNE GARCIA VILLANUEVA M.D.

Table of content: DR. WAYNE GARCIA VILLANUEVA M.D. (NPI 1861483265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861483265 NPI number — DR. WAYNE GARCIA VILLANUEVA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILLANUEVA
Provider First Name:
WAYNE
Provider Middle Name:
GARCIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1861483265
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 950248
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40295-0248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-489-5730
Provider Business Mailing Address Fax Number:
502-489-5753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 KRESGE WAY
Provider Second Line Business Practice Location Address:
SUITE 51
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-891-8981
Provider Business Practice Location Address Fax Number:
502-891-4548
Provider Enumeration Date:
11/03/2005

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: 207T00000X , with the licence number:  31793 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3697391000 . This is a "PASSPORT ADVTG - NNIKY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000604904 . This is a "ANTHEM - NNIKY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1141292 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: KY9351P . This is a "SIHO" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 102723 . This is a "SIHO - NNIKY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64317936 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 140006424 . This is a "RAILROAD MCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 8242027 . This is a "CIGNA - NNIKY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000193902 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50022596 . This is a "PASSPORT - NNIKY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: B06010 . This is a "CUMBERLAND" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200088270 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000023035N . This is a "HUMANA - NNIKY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 00533105 . This is a "MEDICARE - KY - NNIKY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00745281 . This is a "RAILROAD MEDICARE KY - NNIKY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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