=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326844457
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON WILEY
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2025
-----------------------------------------------------
Last Update Date | 02/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 W SYCAMORE
-----------------------------------------------------
City | WESTERN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68464-2298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-432-6505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 486
-----------------------------------------------------
City | WESTERN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68464-0486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-432-6505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------