1134184674 NPI number — MR. EMORY J HILTON DPM

Table of content: MR. EMORY J HILTON DPM (NPI 1134184674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134184674 NPI number — MR. EMORY J HILTON DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILTON
Provider First Name:
EMORY
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1134184674
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1502 NORTH STRONG BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCALESTER
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74501-3842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-426-3668
Provider Business Mailing Address Fax Number:
918-426-3654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1502 NORTH STRONG BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCALESTER
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74501-3842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-426-3668
Provider Business Practice Location Address Fax Number:
918-426-3654
Provider Enumeration Date:
04/18/2006

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: 213E00000X , with the licence number:  210 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200007670A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: U86548 . This is a "STERLING OPTION 1" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 74502A047 . This is a "CHAMPUS (WPS)" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 0166707 . This is a "UMWA" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 731310891006 . This is a "UNICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 731310891028 . This is a "TRICARE SOUTH" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 1324230001 . This is a "PALMETTO DME" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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