1881645273 NPI number — WASON W LOUIE MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881645273 NPI number — WASON W LOUIE MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LOUIE

Provider First Name:

WASON

Provider Middle Name:

W

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1881645273

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/31/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

4750 HEMPSTEAD STATION DR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

KETTERING

Provider Business Mailing Address State Name:

OH

Provider Business Mailing Address Postal Code:

45429-5164

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

800-875-0136

Provider Business Mailing Address Fax Number:

937-619-4342

Provider First Line Business Practice Location Address:

800 MERCY DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

COUNCIL BLUFFS

Provider Business Practice Location Address State Name:

IA

Provider Business Practice Location Address Postal Code:

51503-3128

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

712-328-5230

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

05/12/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207P00000X , with the licence number:  35663 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 03665 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 37051 . This is a "WELLMARK BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 39-01956 . This is a "SHAREADVANTAGE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 39-01958 . This is a "SHARE ADVANTAGE IOWA" identifier . This identifiers is of the category "OTHER".
• Identifier: 100249951-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: P00170245 . This is a "RRMEDICARE IOWA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 0719153 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 100251147-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 100251217-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 39-01955 . This is a "SHAREADVANTAGE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 0443440 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 04307 . This is a "BCBSNE FOR IOWA" identifier . This identifiers is of the category "OTHER".
• Identifier: 244686 . This is a "MLDCH & MUTUAL OF OMAHA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 4443440 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".