1629026125 NPI number — DR. WAYNE JAMES HARPER EDD

Table of content: DR. WAYNE JAMES HARPER EDD (NPI 1629026125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629026125 NPI number — DR. WAYNE JAMES HARPER EDD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARPER
Provider First Name:
WAYNE
Provider Middle Name:
JAMES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
EDD
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:
1629026125
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 436503
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:
40253-6503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-882-1831
Provider Business Mailing Address Fax Number:
502-365-3015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
138 EVERGREEN RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40243-1410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-882-1831
Provider Business Practice Location Address Fax Number:
502-365-3015
Provider Enumeration Date:
05/05/2006

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: 103TC0700X , with the licence number:  1069 , 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: 090226000 . This is a "WH MAGELLAN ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1069 . This is a "LICENSED PSYCHOLOGIST" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 312226 . This is a "WH UBH CLAIMS UT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000383490 . This is a "WH ANTHEM FEP FED EMP PRO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0682204 . This is a "WH ADMINISTAR FEDERAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000383490 . This is a "WH BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611131420 . This is a "WH CORPHEALTH CLAIMS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611131420 . This is a "WH HUMANA CLAIMS OFC LEX" identifier . This identifiers is of the category "OTHER".
  • Identifier: 155537 . This is a "WH VALUE OPTIONS INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8901069800 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 171301561 . This is a "CIGNA HEALTH CARE" identifier . This identifiers is of the category "OTHER".




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