1144534793 NPI number — ZEEDUB LLC

Table of content: BRIAN QUINTEN THOMAS LPN (NPI 1346418100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144534793 NPI number — ZEEDUB LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZEEDUB LLC
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:
6
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:
1144534793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4807 ILLINOIS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46804-1165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-918-0933
Provider Business Mailing Address Fax Number:
260-918-0931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4807 ILLINOIS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46804-1165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-918-0933
Provider Business Practice Location Address Fax Number:
260-918-0931
Provider Enumeration Date:
08/05/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZISHKA
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
FREDRICK
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
260-918-0933

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  APPLICATION PENDING , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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