1033239769 NPI number — CALVIN K HOYLE CP, BOCO, C-PED

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033239769 NPI number — CALVIN K HOYLE CP, BOCO, C-PED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOYLE
Provider First Name:
CALVIN
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CP, BOCO, C-PED
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033239769
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2406 SUSANNAH ST
Provider Second Line Business Mailing Address:
LOWER LEVEL
Provider Business Mailing Address City Name:
JOHNSON CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37601-1725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-975-5462
Provider Business Mailing Address Fax Number:
423-975-5463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2406 SUSANNAH ST
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37601-1725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-975-5462
Provider Business Practice Location Address Fax Number:
423-975-5463
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 222Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 224P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1455141 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4145147 . This is a "BSCBS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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