1801827449 NPI number — BRIAN C WEIS MD

Table of content: BRIAN C WEIS MD (NPI 1801827449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801827449 NPI number — BRIAN C WEIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEIS
Provider First Name:
BRIAN
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1801827449
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5012 S US HWY 75
Provider Second Line Business Mailing Address:
SUITE 300 ATTN. BILLING
Provider Business Mailing Address City Name:
DENISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75020-4587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-351-7200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1411 E AMARILLO BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79107-5555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-351-7200
Provider Business Practice Location Address Fax Number:
806-351-7274
Provider Enumeration Date:
07/05/2006

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: 207R00000X , with the licence number:  L1235 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200043940A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 146828205 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1468282-06 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 146828203 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05705355 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com