Provider Demographics
NPI:1306133475
Name:WIEGANDT AND ASSOCIATES PC
Entity type:Organization
Organization Name:WIEGANDT AND ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIZBETH
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-295-4902
Mailing Address - Street 1:2621 CRANBERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-1004
Mailing Address - Country:US
Mailing Address - Phone:508-295-4902
Mailing Address - Fax:508-295-2455
Practice Address - Street 1:2621 CRANBERRY HWY
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-1004
Practice Address - Country:US
Practice Address - Phone:508-295-4902
Practice Address - Fax:508-295-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57120174400000X, 302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1285692525Medicaid