1043552193 NPI number — DR. KIMBERLY D. HAUG, PC

Table of content: (NPI 1043552193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043552193 NPI number — DR. KIMBERLY D. HAUG, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. KIMBERLY D. HAUG, PC
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:
ACCLAIMED ORTHODONTICS
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:
1043552193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2411 MORNING STAR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62002-5657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-463-7002
Provider Business Mailing Address Fax Number:
618-463-7006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 CENTRAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62249-1175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-654-8017
Provider Business Practice Location Address Fax Number:
618-654-4124
Provider Enumeration Date:
03/26/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAUG
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
DOCTOR/OWNER
Authorized Official Telephone Number:
618-654-8017

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  021.001908 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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