1447333083 NPI number — NICHOLAS JOSEPH HILL

Table of content: NICHOLAS JOSEPH HILL (NPI 1447333083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447333083 NPI number — NICHOLAS JOSEPH HILL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILL
Provider First Name:
NICHOLAS
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1447333083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
141 NE 770
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-885-2970
Provider Business Mailing Address Fax Number:
660-885-8496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 NORTH SECOND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64735-1192
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-890-7103
Provider Business Practice Location Address Fax Number:
660-885-8496
Provider Enumeration Date:
10/24/2006

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: 367500000X , with the licence number:  080112 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 91285454 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".