1659552255 NPI number — JEFFREY M WISSER DO LLC

Table of content: (NPI 1659552255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659552255 NPI number — JEFFREY M WISSER DO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY M WISSER DO 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:
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:
1659552255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 W HIGH ST
Provider Second Line Business Mailing Address:
SUITE 330
Provider Business Mailing Address City Name:
LIMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45801-2969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-228-1077
Provider Business Mailing Address Fax Number:
419-228-1075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 W HIGH ST
Provider Second Line Business Practice Location Address:
SUITE 330
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45801-2969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-228-1077
Provider Business Practice Location Address Fax Number:
419-228-1075
Provider Enumeration Date:
11/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WISSER
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
419-228-1077

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DD6265 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com