Provider Demographics
NPI:1235752460
Name:WHEAT L L C
Entity Type:Organization
Organization Name:WHEAT L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:F
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-528-2836
Mailing Address - Street 1:2627 NE 203RD ST STE 109
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1945
Mailing Address - Country:US
Mailing Address - Phone:305-528-2836
Mailing Address - Fax:305-682-8994
Practice Address - Street 1:2627 NE 203RD ST STE 109
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-1945
Practice Address - Country:US
Practice Address - Phone:305-528-2836
Practice Address - Fax:305-682-8994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No332900000XSuppliersNon-Pharmacy Dispensing Site
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2181154OtherCLIA
FLE063187OtherINSURANCE 2-15
FL6011757OtherHEALTH CARE CLINIC ESTABLSHMENT
FL13-64-202-7797OtherBIOMEDICAL WASTE CLINICAL LABORATORY