1265410393 NPI number — DR. CHRISTINE WEYMAN MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265410393 NPI number — DR. CHRISTINE WEYMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEYMAN
Provider First Name:
CHRISTINE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1265410393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 BOURNE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42501-1916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-678-4761
Provider Business Mailing Address Fax Number:
606-676-9671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 ROBERTS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42501-1295
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-679-4416
Provider Business Practice Location Address Fax Number:
606-679-4419
Provider Enumeration Date:
01/09/2006

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: 2083P0901X , with the licence number:  28428 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 28428 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 20001012 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20023016 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20100012 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 600000712 . This is a "RR MEDICARE ADAIR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 600000716 . This is a "RR MEDICARE GREEN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 20044012 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20074019 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 600000714 . This is a "RR MEDICARE CLINTON" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 20104014 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 600000718 . This is a "RR MEDICARE PULASKI" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 20027017 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20029013 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 600000722 . This is a "RR MEDICARE WAYNE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 20901211 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 600000717 . This is a "RR MEDICARE MCCREARY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 600000719 . This is a "RR MEDICARE RUSSELL" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 600000720 . This is a "RR MEDICARE TAYLOR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 600000713 . This is a "RR MEDICARE CASEY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 600000715 . This is a "RR MEDICARE CUMBERLAND" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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