1457591471 NPI number — DR. SHAWN DOUGLAS HICKS M.D., MSC

Table of content: DR. SHAWN DOUGLAS HICKS M.D., MSC (NPI 1457591471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457591471 NPI number — DR. SHAWN DOUGLAS HICKS M.D., MSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HICKS
Provider First Name:
SHAWN
Provider Middle Name:
DOUGLAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., MSC
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:
1457591471
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
123 ECHO DR
Provider Second Line Business Mailing Address:
UNIT 207
Provider Business Mailing Address City Name:
OTTAWA
Provider Business Mailing Address State Name:
ONTARIO
Provider Business Mailing Address Postal Code:
K1S 1M9
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
613-233-9280
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3550 TERRACE ST
Provider Second Line Business Practice Location Address:
655 SCAIF HALL
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15213-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-647-6249
Provider Business Practice Location Address Fax Number:
412-578-9340
Provider Enumeration Date:
03/03/2009

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: 207LC0200X , with the licence number:  MT194194 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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