1306994611 NPI number — CHARLES HUGHES HUBBERT M. D.

Table of content: CHARLES HUGHES HUBBERT M. D. (NPI 1306994611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306994611 NPI number — CHARLES HUGHES HUBBERT M. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUBBERT
Provider First Name:
CHARLES
Provider Middle Name:
HUGHES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M. D.
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:
1306994611
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MEMPHIS VA HOSPITAL, DEPT. NEUROLOGY
Provider Second Line Business Mailing Address:
1030 JEFFERSON AVENUE
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-577-8990
Provider Business Mailing Address Fax Number:
901-577-7486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MEMPHIS VA HOSPITAL, DEPT. NEUROLOGY
Provider Second Line Business Practice Location Address:
1030 JEFFERSON AVENUE
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-577-8990
Provider Business Practice Location Address Fax Number:
901-577-7486
Provider Enumeration Date:
01/05/2007

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: 2084P0800X , with the licence number:  MD5460 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 5460 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 31020301 . This is a "MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4159798 . This is a "BCBS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3102034 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".