1932191590 NPI number — DR. BENJAMIN Y WANG MD

Table of content: DR. BENJAMIN Y WANG MD (NPI 1932191590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932191590 NPI number — DR. BENJAMIN Y WANG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WANG
Provider First Name:
BENJAMIN
Provider Middle Name:
Y
Provider Name Prefix Text:
DR.
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:
1932191590
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2030
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOWELL
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72745-2030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-381-9178
Provider Business Mailing Address Fax Number:
913-234-1116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 N OREGON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79902-3320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-577-6011
Provider Business Practice Location Address Fax Number:
915-577-7068
Provider Enumeration Date:
08/19/2005

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: 2085R0202X , with the licence number:  K4604 , 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: 16427726 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00995222 . This is a "RR MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 044009102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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