Provider Demographics
NPI:1649240995
Name:MICHAEL O. WENDT, LLC
Entity Type:Organization
Organization Name:MICHAEL O. WENDT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:WENDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-454-2600
Mailing Address - Street 1:PO BOX 2564
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-2564
Mailing Address - Country:US
Mailing Address - Phone:803-765-1838
Mailing Address - Fax:803-765-1732
Practice Address - Street 1:139 SUMMERPLACE DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3058
Practice Address - Country:US
Practice Address - Phone:803-765-1838
Practice Address - Fax:803-765-1732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4114Medicaid
SC8201Medicare PIN