Healthcare Provider Details

I. General information

NPI: 1730153586
Provider Name (Legal Business Name): NEIL R. WANEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60021 MONROE ST
SMITHVILLE MS
38870-7779
US

IV. Provider business mailing address

PO BOX 305
SMITHVILLE MS
38870-0305
US

V. Phone/Fax

Practice location:
  • Phone: 662-651-4637
  • Fax: 662-651-4636
Mailing address:
  • Phone: 662-651-4637
  • Fax: 662-651-4636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberIN01033830
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23359
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: