1437178613 NPI number — NANCY WEBER INC

Table of content: (NPI 1437178613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437178613 NPI number — NANCY WEBER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NANCY WEBER 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:
6
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:
1437178613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1880 AUBURN LN
Provider Second Line Business Mailing Address:
24 H
Provider Business Mailing Address City Name:
SURFSIDE BEACH
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29575-5196
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-839-9088
Provider Business Mailing Address Fax Number:
888-909-5897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11945 GRANDHAVEN DR
Provider Second Line Business Practice Location Address:
STE G
Provider Business Practice Location Address City Name:
MURRELLS INLET
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29576-8091
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-839-9088
Provider Business Practice Location Address Fax Number:
888-909-5897
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEBER
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
843-957-4457

Provider Taxonomy Codes

  • Taxonomy code: 133VN1005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GRP6793 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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