1538112834 NPI number — MR. JOHN H WEAR P.T.

Table of content: MR. JOHN H WEAR P.T. (NPI 1538112834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538112834 NPI number — MR. JOHN H WEAR P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEAR
Provider First Name:
JOHN
Provider Middle Name:
H
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
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:
1538112834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12425 N 96TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68122-2033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-917-2020
Provider Business Mailing Address Fax Number:
402-571-3229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12425 N 96TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68122-2033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-917-2020
Provider Business Practice Location Address Fax Number:
402-571-3229
Provider Enumeration Date:
05/18/2006

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: 225100000X , with the licence number:  1156 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 02875 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251E1200X , with the licence number: 1156 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251E1200X , with the licence number: 02875 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251G0304X , with the licence number: 1156 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251G0304X , with the licence number: 02875 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251H1300X , with the licence number: 1156 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251H1300X , with the licence number: 02875 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251S0007X , with the licence number: 1156 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251S0007X , with the licence number: 02875 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X , with the licence number: 1156 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X , with the licence number: 02875 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 264838 . This is a "COVENTRY" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 39856 . This is a "BCBS PIN1" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: NE-1945-1002 . This is a "PREFERRED THERAPY PROVIDE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 98985 . This is a "BC/BS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: BA-5551648 . This is a "MULTIPLAN" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: F244798 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 36530 . This is a "BC/BS NEBRASKA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 09248 . This is a "BC/BS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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