1831192244 NPI number — WUESTHOFF EMERGENCY PHYSICIANS PA

Table of content: (NPI 1831192244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831192244 NPI number — WUESTHOFF EMERGENCY PHYSICIANS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WUESTHOFF EMERGENCY PHYSICIANS PA
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:
1831192244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30731
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33630-3731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-476-8646
Provider Business Mailing Address Fax Number:
919-382-3210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 LONGWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKLEDGE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32955-2828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-476-8646
Provider Business Practice Location Address Fax Number:
919-382-3210
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NICHOL
Authorized Official First Name:
CURRIN
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
800-476-7646

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , 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)

  • Identifier: 45368 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 259751900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com