=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144594938
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEIM,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2012
-----------------------------------------------------
Last Update Date | 02/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14837 DETROIT AVE 307
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44107-3909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-952-1490
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14837 DETROIT AVE 307
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44107-3909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-952-1490
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DONALD AMMON JR.
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 216-952-1490
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 2079679
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------