1083003040 NPI number — WELDON MEDICAL PRODUCTS INC.

Table of content: (NPI 1083003040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083003040 NPI number — WELDON MEDICAL PRODUCTS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELDON MEDICAL PRODUCTS INC.
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:
1083003040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 S COLLEGE ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
MACCLENNY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32063-2439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-472-5374
Provider Business Mailing Address Fax Number:
904-259-0579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 S COLLEGE ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
MACCLENNY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32063-2439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-472-5374
Provider Business Practice Location Address Fax Number:
904-259-0579
Provider Enumeration Date:
01/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
WELDON
Authorized Official First Name:
TYLER
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
OWNER/OPERATOR
Authorized Official Telephone Number:
904-237-5648

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  PED 228 , 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: 224L00000X . This is a "CMS- TAXONOMY CODE FOR 'PEDORTHIST'" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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