Dr Wendell Hayden Wilmoth, MD | |
1915 E Rezanof Dr, Kodiak, AK 99615-6602 | |
(907) 486-9581 | |
Not Available |
Full Name | Dr Wendell Hayden Wilmoth |
---|---|
Gender | Male |
Speciality | Radiology - Diagnostic Radiology |
Location | 1915 E Rezanof Dr, Kodiak, Alaska |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1245499003 | NPI | - | NPPES |
1585319 | Medicaid | AK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2085R0202X | Radiology - Diagnostic Radiology | 7852 (Alaska) | Primary |
Entity Name | Miners' Colfax Medical Center |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1083931109 PECOS PAC ID: 5294647400 Enrollment ID: O20031105000106 |
Entity Name | Miners' Colfax Medical Center |
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Entity Type | Part A Provider - Critical Access Hospital |
Entity Identifiers | NPI Number: 1083931109 PECOS PAC ID: 5294647400 Enrollment ID: O20100514000911 |
Entity Name | Miners' Colfax Medical Center |
---|---|
Entity Type | Part A Provider - Critical Access Hospital |
Entity Identifiers | NPI Number: 1083931109 PECOS PAC ID: 5294647400 Enrollment ID: O20110317000764 |
Entity Name | Concord Radiology Pllc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1598260515 PECOS PAC ID: 8628332061 Enrollment ID: O20191002001421 |
Mailing Address | Practice Location Address |
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Dr Wendell Hayden Wilmoth, MD Po Box 10107, Knoxville, TN 37939-0107 Ph: (865) 584-7376 | Dr Wendell Hayden Wilmoth, MD 1915 E Rezanof Dr, Kodiak, AK 99615-6602 Ph: (907) 486-9581 |
Dr. Hans Ulrich Tschersich, MD Radiology Medicare: Not Enrolled in Medicare Practice Location: 1915 East Rezanof Drive, Kodiak, AK 99615 Phone: 907-486-9521 Fax: 907-486-9523 |