1568177939 NPI number — WES J IRWIN MD MS INC

Table of content: (NPI 1568177939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568177939 NPI number — WES J IRWIN MD MS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WES J IRWIN MD MS 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:
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:
1568177939
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
710 LASSEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH LAKE TAHOE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96150-4446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-545-1175
Provider Business Mailing Address Fax Number:
530-231-0601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 E 2ND ST STE 1230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89501-1587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-545-1175
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/19/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
IRWIN
Authorized Official First Name:
WES
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
530-545-1175

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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