1598747743 NPI number — HUGH E HART CRNA

Table of content: HUGH E HART CRNA (NPI 1598747743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598747743 NPI number — HUGH E HART CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HART
Provider First Name:
HUGH
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1598747743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 LAKESHORE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ISHPEMING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49849-1367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-485-2708
Provider Business Mailing Address Fax Number:
906-487-2743

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 LAKESHORE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ISHPEMING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49849-1367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-485-2708
Provider Business Practice Location Address Fax Number:
906-487-2743
Provider Enumeration Date:
11/15/2005

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: 367500000X , with the licence number:  4704119655 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 430023600 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: HH119655 . This is a "BLUESHIELD PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 43400400 . This is a "WISC MEDICAID PIN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 101599720 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".