1396926424 NPI number — ERIC HUNT WIGTON M.D.

Table of content: STEPHANIE GONZALEZ ARNP (NPI 1558754457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396926424 NPI number — ERIC HUNT WIGTON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIGTON
Provider First Name:
ERIC
Provider Middle Name:
HUNT
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:
1396926424
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3990 N ILLINOIS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SWANSEA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62226-1919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-277-1130
Provider Business Mailing Address Fax Number:
618-277-4917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3990 N ILLINOIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWANSEA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62226-1919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-277-1130
Provider Business Practice Location Address Fax Number:
618-277-4917
Provider Enumeration Date:
11/16/2007

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: 207W00000X , with the licence number:  29048 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 051117260 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 128667 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051117254 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 128661 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051117258 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 07805726 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 128645 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051117262 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051117253 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051117259 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 128646 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 128662 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 128660 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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