1619134632 NPI number — ERVIN JACKSON HUDGINS DC PA

Table of content: (NPI 1619134632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619134632 NPI number — ERVIN JACKSON HUDGINS DC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERVIN JACKSON HUDGINS DC PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BEYOND CHIROPRACTIC
Provider Other Organization Name Type Code:
5
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:
1619134632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7214 HIGHWAY 78
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
SACHSE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75048-2532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-429-6379
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7214 HIGHWAY 78
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
SACHSE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75048-2532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-429-6379
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HUDGINS
Authorized Official First Name:
ERVIN
Authorized Official Middle Name:
JACKSON
Authorized Official Title or Position:
CHIROPRACTIC OWNER
Authorized Official Telephone Number:
806-794-6907

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  9273 , 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: 9365910 . This is a "FIRSTCARE PHCS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: U91516 . This is a "ALL COMMERCIAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00200813 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: U91516 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: B0082216 . This is a "BLUECROSSBLUESHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: U91516 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com