1487780458 NPI number — WENDY HUMPHREY VAN METER DMD

Table of content: WENDY HUMPHREY VAN METER DMD (NPI 1487780458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487780458 NPI number — WENDY HUMPHREY VAN METER DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN METER
Provider First Name:
WENDY
Provider Middle Name:
HUMPHREY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUMPHREY
Provider Other First Name:
WENDY
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487780458
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
181 W LOWRY LN
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40503-3016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-277-5437
Provider Business Mailing Address Fax Number:
859-277-8827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
181 W LOWRY LN
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40503-3016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-277-5437
Provider Business Practice Location Address Fax Number:
859-277-8827
Provider Enumeration Date:
02/26/2007

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: 122300000X , with the licence number:  7980 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X , with the licence number: 7980 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 60002839 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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