Provider Demographics
NPI:1619919065
Name:GE WIESE DBA
Entity Type:Organization
Organization Name:GE WIESE DBA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WIESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-768-1818
Mailing Address - Street 1:714 N BEDELL AVE
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-4111
Mailing Address - Country:US
Mailing Address - Phone:830-768-1818
Mailing Address - Fax:830-778-8618
Practice Address - Street 1:714 N BEDELL AVE
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-4111
Practice Address - Country:US
Practice Address - Phone:830-768-1818
Practice Address - Fax:830-778-8618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0410070003Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
TX0410070004Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID