1194783761 NPI number — DR. HARVEY M WIENER DO

Table of content: DR. HARVEY M WIENER DO (NPI 1194783761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194783761 NPI number — DR. HARVEY M WIENER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIENER
Provider First Name:
HARVEY
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1194783761
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 S ASHLEY DR
Provider Second Line Business Mailing Address:
SUITE 1500
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33602-5304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-899-6223
Provider Business Mailing Address Fax Number:
813-984-7192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 S ASHLEY DR
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33602-5304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-899-6223
Provider Business Practice Location Address Fax Number:
813-984-7192
Provider Enumeration Date:
05/03/2006

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: 2085R0204X , with the licence number:  OS 8668 , 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: 1Z7049 . This is a "HEALTHNET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 470001313 . This is a "RAILRD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0324990 . This is a "BCBS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 312398 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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