Active NPI
Larry Michael Wiedenhoft, EMT
- Emergency Medical Services (Emergency Medicine) Physician
- Manzanita, OR
National Provider Identifier
1972139418
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medical Services (Emergency Medicine) Physician
- License
- 143317
- Practice address
- 465 Manzanita Ave
Manzanita, OR 97130-0810 - Phone
- (503) 704-1006
- NPI assigned
- Mar 17, 2020
- Last updated
- Mar 17, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medical Services (Emergency Medicine) Physician | 207PE0004X | 143317 | OR | Primary |
Addresses
Primary practice location
465 Manzanita Ave
Manzanita, OR 97130-0810
Mailing address
PO Box 810
Manzanita, OR 97130-0810
Phone (503) 704-1006
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Emergency Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 143317 | OR | MD | Emergency Medical Services (Emergency Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584403200000",
"number": "1972139418",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 810",
"city": "MANZANITA",
"state": "OR",
"postal_code": "971300810",
"telephone_number": "503-704-1006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "465 MANZANITA AVE",
"city": "MANZANITA",
"state": "OR",
"postal_code": "971300810",
"telephone_number": "503-704-1006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIEDENHOFT",
"first_name": "LARRY",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "EMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-17",
"last_updated": "2020-03-17",
"certification_date": "2020-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "207PE0004X",
"taxonomy_group": "",
"desc": "Emergency Medicine, Emergency Medical Services",
"state": "OR",
"license": "143317",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manzanita, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.