1093705360 NPI number — CLIFTON HILL CATHCART JR. D.O.

Table of content: CLIFTON HILL CATHCART JR. D.O. (NPI 1093705360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093705360 NPI number — CLIFTON HILL CATHCART JR. D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CATHCART
Provider First Name:
CLIFTON
Provider Middle Name:
HILL
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
D.O.
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:
1093705360
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MEDICAL CENTER BLVD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUFKIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75904-3173
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-639-1224
Provider Business Mailing Address Fax Number:
936-632-9322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEDICAL CENTER BLVD # A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUFKIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75904-3173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-639-1224
Provider Business Practice Location Address Fax Number:
936-637-7917
Provider Enumeration Date:
10/26/2005

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: 208VP0000X , with the licence number:  F0412 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: F0412 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 752934073 . This is a "PAIN AND POSTURE TXID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 826086353 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 155299401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00CA20 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 032423803 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 751778755 . This is a "TAX ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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