MR. LARRY MICHAEL WIEDENHOFT (NPI# 1972139418) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972139418 |
| Entity Type | Individual |
| Full Name | MR. LARRY MICHAEL WIEDENHOFT |
| Credential | EMT |
| Practice Address |
465 Manzanita Ave Manzanita OR 97130-0810 |
| Mailing Address |
Po Box 810 Manzanita OR 97130-0810 |
| Practice Telephone | 5037041006 |
| Mailing Telephone | 5037041006 |
| Enumeration Date | 2020-03-17 |
| Last Update Date | 2020-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
143317 | OR | Allopathic & Osteopathic Physicians |
| Street Address |
465 MANZANITA AVE |
| City | MANZANITA |
| State | OR |
| Zip Code | 97130-0810 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477118032 | Pauseful LLC | Massage Therapist | 298 Laneda Ave, Suite 6, Manzanita, OR 97130 | 2019-05-08 |
| 1790109023 | Weichert Wellness, LLC | Clinic/Center | 123 Laneda Avenue, Manzanita, OR 97130 | 2014-02-06 |
| 1508106766 | Amy Pulitzer | Counselor | 181 Laneda Ave., Manzanita, OR 97130 | 2013-02-26 |
| 1104192871 | Jamie E Ehrke | Specialist | 123 Laneda Ave, Manzanita, OR 97130 | 2012-03-28 |
| 1154699379 | Northwest Medical Foundation of Tillamook | General Acute Care Hospital | 10445 Neah-kah-nie Cr Rd, Manzanita, OR 97130 | 2011-12-02 |
| 1588930945 | Longevity | Community/Behavioral Health | 123 Laneda Ave, Manzanita, OR 97130 | 2012-03-29 |
| 1174643738 | John Clark Miller | Counselor | 60 Laneda Avenue, Suite 202, Manzanita, OR 97130-0000 | 2007-03-29 |
| 1508396326 | Orthopedic Toe Guard | Durable Medical Equipment & Medical Supplies | 611 Ocean Ave., Po Box100, Manzanita, OR 97130-0100 | 2017-06-14 |
| 1538591698 | Amber Lee Donahue | Specialist | 298 Laneda Ave., Manzanita, OR 97130-0415 | 2013-07-31 |
| 1811062748 | Stefan J Malecek | Counselor | 455 North Ave, Manzanita, OR 97130-0776 | 2006-11-24 |
| Find all providers in zip 97130 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184829244 | Se Jung Shin Md Professional Corporation | Emergency Medicine | 13305 Nw Cornell Road, Suite C, Portland, OR 97229 | 2007-06-19 |
| 1104028059 | Annameika Eve Goldring | Emergency Medicine | 3181 S.w. Sam Jackson Park Rd., Portland, OR 97239 | 2007-06-04 |
| 1053467985 | Brian Murray Auld | Emergency Medicine | 3621 Elderberry Dr S, Salem, OR 97302-4054 | 2007-01-25 |
| 1750448981 | Carl M Melina | Emergency Medicine | 18610 Nw Cornell Road, Suite 100, Hillsboro, OR 97124-9923 | 2007-01-03 |
| 1023103546 | Michael F. Mccaskill | Emergency Medicine | 436 Timber Lane, Grants Pass, OR 97526 | 2006-10-03 |
| 1366486912 | Mark A Stefanelli | Emergency Medicine | 2647 Grand Ave, Astoria, OR 97103-3329 | 2006-06-15 |
| 1801845953 | David Ernest Magaret | Emergency Medicine | 1201 Ne Elm St, Prineville, OR 97754-1206 | 2006-05-08 |
| 1649235219 | Victoria V Harris | Emergency Medicine | 100 E. Main Street, Suite C, Medford, OR 97501-6041 | 2006-04-18 |
| 1003870536 | Brad Barlow | Emergency Medicine | 351 Sw 9th St, Ontario, OR 97914-2639 | 2006-04-13 |
| 1285602086 | Erin P Reilly | Emergency Medicine | 860 Beltline Rd, Springfield, OR 97477-1091 | 2006-03-09 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.