Provider Demographics
NPI:1760693071
Name:NANCY E WEIBLE
Entity Type:Organization
Organization Name:NANCY E WEIBLE
Other - Org Name:NAN FAMILY HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:WEIBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-288-8004
Mailing Address - Street 1:6120 U S HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7300
Mailing Address - Country:US
Mailing Address - Phone:601-288-8004
Mailing Address - Fax:601-288-8012
Practice Address - Street 1:6120 U S HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7300
Practice Address - Country:US
Practice Address - Phone:601-288-8004
Practice Address - Fax:601-288-8012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12913207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0130116OtherUNITED HEALTHCARE INDIVIDUAL
MS00119477OtherMEDICAID INDIVIDUAL
MS5266238OtherAETNA INDIVIDUAL
MS080154729OtherMEDICARE RR INDIVIDUAL
MS500749239IOtherBLUE CROSS INDIVIDUAL
MS9015909Medicaid
MSC02742Medicare Oscar/Certification
MS5266238OtherAETNA INDIVIDUAL
MS9015909Medicaid