Basic Information
| Provider Information | |||||||||
| NPI: | 1356760243 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELLER | ||||||||
| FirstName: | TITUS | ||||||||
| MiddleName: | JACK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MT CARMEL WAY | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667627587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202316100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 MT CARMEL WAY | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667627587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202316100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2014 | ||||||||
| LastUpdateDate: | 04/02/2018 | ||||||||
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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 | 2018004967 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 04-38784 | KS | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.