1639313000 NPI number — MR. JAMES L. WIMS C.S.T./C.S.F.A/SA-C

Table of content: MR. JAMES L. WIMS C.S.T./C.S.F.A/SA-C (NPI 1639313000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639313000 NPI number — MR. JAMES L. WIMS C.S.T./C.S.F.A/SA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIMS
Provider First Name:
JAMES
Provider Middle Name:
L.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
C.S.T./C.S.F.A/SA-C
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:
1639313000
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1830
Provider Second Line Business Mailing Address:
619 N.E. 7TH AVE.
Provider Business Mailing Address City Name:
CRYSTAL RIVER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34423-1830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-563-7032
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10495 N FLORIDA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CITRUS SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34434-3268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-465-5663
Provider Business Practice Location Address Fax Number:
352-465-5664
Provider Enumeration Date:
04/28/2009

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: 246ZS0410X , with the licence number:  105719 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 246ZC0007X , with the licence number: 117931 , 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)





Copyright © 2007-2024 www.npivalidator.com