1740211911 NPI number — DR. JOHN C HOUCHINS MD

Table of content: DR. JOHN C HOUCHINS MD (NPI 1740211911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740211911 NPI number — DR. JOHN C HOUCHINS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOUCHINS
Provider First Name:
JOHN
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
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:
1740211911
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3860 W OGDEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60623-2460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
872-588-3000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3860 W OGDEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60623-2460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
872-588-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2006

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: 207Q00000X , with the licence number:  172212-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7081524 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 870564069HOU . This is a "EMIA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: XPY197122 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 122808100 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 190475000 . This is a "DEPT OF LABOR" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 04821 . This is a "UUHSC" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 1061 . This is a "U HEALTH PLAN" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 11249 . This is a "DMBA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 49934 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: PRA01489 . This is a "MOLINA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: QM0000053151 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 107005326101 . This is a "IHC" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".