1134100308 NPI number — DR. JOHN M WEEMAN MD

Table of content: DR. JOHN M WEEMAN MD (NPI 1134100308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134100308 NPI number — DR. JOHN M WEEMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEEMAN
Provider First Name:
JOHN
Provider Middle Name:
M
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:
1134100308
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
546 WINTER ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WOOSTER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44691-2300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-345-2229
Provider Business Mailing Address Fax Number:
330-345-2236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
546 WINTER ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WOOSTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44691-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-345-2229
Provider Business Practice Location Address Fax Number:
330-345-2236
Provider Enumeration Date:
11/07/2005

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: 207V00000X , with the licence number:  35060382 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 33730 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0701755 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4374358 . This is a "AETNA PPO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0911928 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5599810 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 141935 . This is a "HEALTHAMERICA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 311537968029 . This is a "CARESOURCE ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000121557 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 733577 . This is a "BUCKEYE ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2082247 . This is a "AETNA HMO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 35060382W . This is a "UNICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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