1598862872 NPI number — HUGH HETHERINGTON, M.D., P.C.

Table of content: (NPI 1598862872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598862872 NPI number — HUGH HETHERINGTON, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUGH HETHERINGTON, M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BIG SKY EAR, NOSE AND THROAT
Provider Other Organization Name Type Code:
3
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:
1598862872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
925 HIGHLAND BLVD
Provider Second Line Business Mailing Address:
SUITE 1160
Provider Business Mailing Address City Name:
BOZEMAN
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59715-6900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-587-5000
Provider Business Mailing Address Fax Number:
406-587-5068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
925 HIGHLAND BLVD
Provider Second Line Business Practice Location Address:
SUITE 1160
Provider Business Practice Location Address City Name:
BOZEMAN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59715-6900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-587-5000
Provider Business Practice Location Address Fax Number:
406-587-5068
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HETHERINGTON
Authorized Official First Name:
HUGH
Authorized Official Middle Name:
ELLIOTT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
406-587-5000

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  10377 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207YX0905X , with the licence number: 6361 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 231H00000X , with the licence number: MT CERTIFICATE # U97 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237700000X , with the licence number: #332HAD , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363A00000X , with the licence number: 227 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 101847 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0064430 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5606198 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0533307 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 435383 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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