Basic Information
| Provider Information | |||||||||
| NPI: | 1881645273 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOUIE | ||||||||
| FirstName: | WASON | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4750 HEMPSTEAD STATION DR | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454295164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008750136 | ||||||||
| FaxNumber: | 9376194342 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 MERCY DR | ||||||||
| Address2: | |||||||||
| City: | COUNCIL BLUFFS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515033128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7123285230 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 06/16/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 35663 | IA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 03665 | 01 | NE | BCBS | OTHER | 37051 | 01 | IA | WELLMARK BCBS | OTHER | 39-01956 | 01 | NE | SHAREADVANTAGE | OTHER | 39-01958 | 01 | SHARE ADVANTAGE IOWA | OTHER | 100249951-00 | 05 | NE | MEDICAID | P00170245 | 01 | IA | RRMEDICARE IOWA | OTHER | 0719153 | 05 | IA | MEDICAID | 100251147-00 | 05 | NE | MEDICAID | 100251217-00 | 05 | NE | MEDICAID | 39-01955 | 01 | NE | SHAREADVANTAGE | OTHER | 0443440 | 05 | IA | MEDICAID | 04307 | 01 | BCBSNE FOR IOWA | OTHER | 244686 | 01 | NE | MLDCH & MUTUAL OF OMAHA | OTHER | 4443440 | 05 | IA | MEDICAID |