1942205851 NPI number — DR. DAVID N WEIDENSAUL MD

Table of content: DR. DAVID N WEIDENSAUL MD (NPI 1942205851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942205851 NPI number — DR. DAVID N WEIDENSAUL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEIDENSAUL
Provider First Name:
DAVID
Provider Middle Name:
N
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:
1942205851
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1712 E. 23RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUTCHINSON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-960-1259
Provider Business Mailing Address Fax Number:
620-662-0538

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 EAST 23RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUTCHINSON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-612-4815
Provider Business Practice Location Address Fax Number:
316-612-4825
Provider Enumeration Date:
06/16/2005

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: 207RR0500X , with the licence number:  0416898 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RR0500X , with the licence number: 04-16898 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 103629 . This is a "MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100194820B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".