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NPI Code Detail

MEDICARE: MR. JOHN HENRY WUEST PA-C

MEDICARE: MR. JOHN HENRY WUEST PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant103677NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548247166
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN HENRY WUEST PA-C
Provider Business Mailing Address
First Line : PO BOX 751069
Second Line : ECU PHYSICIANS
City : CHARLOTTE
State : NC
Zip : 28275-1069
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 628 E 12TH ST
Second Line : VIDANT BEAUFORT HOSPITAL
City : WASHINGTON
State : NC
Zip : 27889-3409
Country : US
Telephone Number : 252-975-4319
Fax Number : 252-975-4185
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2005
Last Update Date : 11/19/2013

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