1083003040 NPI number — WELDON MEDICAL PRODUCTS 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 1083003040 NPI number — WELDON MEDICAL PRODUCTS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELDON MEDICAL PRODUCTS 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:
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:
1083003040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 S COLLEGE ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
MACCLENNY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32063-2439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-472-5374
Provider Business Mailing Address Fax Number:
904-259-0579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 S COLLEGE ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
MACCLENNY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32063-2439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-472-5374
Provider Business Practice Location Address Fax Number:
904-259-0579
Provider Enumeration Date:
01/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
WELDON
Authorized Official First Name:
TYLER
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
OWNER/OPERATOR
Authorized Official Telephone Number:
904-237-5648

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  PED 228 , 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: 224L00000X . This is a "CMS- TAXONOMY CODE FOR 'PEDORTHIST'" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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