NPI |
1124143896 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
DAVID D. WYSE, D.D.S., P.C. |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider First Line Business Practice Location Address |
207 S PROSPECT RD |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Second Line Business Practice Location Address |
STE. 2 |
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
Provider Business Practice Location Address City Name |
BLOOMINGTON |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
IL |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
617044905 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
3096636393 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
3096640366 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
3/20/2007 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
10/3/2013 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
WYSE |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Authorized Official First Name |
DAVID |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Authorized Official Middle Name |
D. |
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Authorized Official Title or Position |
OWNER |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Authorized Official Telephone Number |
3096636393 |
Other name by which the organization provider is or has been known. |
Healthcare Provider Taxonomy Code 1 |
261QD0000X |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider License Number 1 |
060001892 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider License Number State Code 1 |
IL |
The city name in the location address of the provider being identified. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The State code in the location of the provider
being identified. |
Is Organization Subpart |
N |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Authorized Official Name Prefix Text |
DR. |
The country code in the location address of the provider being identified. |
Authorized Official Credential Text |
DDS |
|