1598711103 NPI number — WINE COUNTRY CARDIOLOGY ASSOCIATES A MEDICAL CORPORATION

Table of content: MRS. JESSICA ELIZABETH WIGGS PCMHT (NPI 1538030846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598711103 NPI number — WINE COUNTRY CARDIOLOGY ASSOCIATES A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINE COUNTRY CARDIOLOGY ASSOCIATES A MEDICAL CORPORATION
Provider Last Name:
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Provider Middle Name:
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Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name:
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NPI Number Information

NPI Number:
1598711103
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
999 ADAMS ST
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
SAINT HELENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94574-1148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-963-4997
Provider Business Mailing Address Fax Number:
707-963-4990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
999 ADAMS ST
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
SAINT HELENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94574-1148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-963-4997
Provider Business Practice Location Address Fax Number:
707-963-4990
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BIETZ
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
707-963-4997

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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