1740349836 NPI number — STANLEY W WHISENANT MD

Table of content: STANLEY W WHISENANT MD (NPI 1740349836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740349836 NPI number — STANLEY W WHISENANT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHISENANT
Provider First Name:
STANLEY
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1740349836
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2931 RIDGE RD
Provider Second Line Business Mailing Address:
STE 101 PMB 159
Provider Business Mailing Address City Name:
ROCKWALL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75032-6684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
945-766-4457
Provider Business Mailing Address Fax Number:
972-777-9939

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 WESLEY ST STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75401-9015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
945-766-4457
Provider Business Practice Location Address Fax Number:
972-777-9939
Provider Enumeration Date:
12/06/2006

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: 207L00000X , with the licence number:  J7725 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , with the licence number: J7725 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 395576 . This is a "WELLCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 688993 . This is a "AMBETTER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8AE000 . This is a "BCBS TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0053MT . This is a "BCBS TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 92272 . This is a "AVAILITY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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