1417941022 NPI number — JOE W HUNT MD

Table of content: JOE W HUNT MD (NPI 1417941022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417941022 NPI number — JOE W HUNT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUNT
Provider First Name:
JOE
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1417941022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 TUCKER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIPLEY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38063-1631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-287-4500
Provider Business Mailing Address Fax Number:
731-287-4804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 TUCKER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIPLEY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38063-1631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-635-4741
Provider Business Practice Location Address Fax Number:
731-635-3466
Provider Enumeration Date:
09/09/2005

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: 207Q00000X , with the licence number:  MD0000013611 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD013611 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 080056360 . This is a "PALMETTO GBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7151 . This is a "TLC (MEMPHIS MAN. CARE)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4025313 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0198620 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0140415 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 116252 . This is a "BETTER HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7781038 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3001790 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0198620 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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