1619927241 NPI number — SAMUEL L HUGHES MD

Table of content: SAMUEL L HUGHES MD (NPI 1619927241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619927241 NPI number — SAMUEL L HUGHES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUGHES
Provider First Name:
SAMUEL
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1619927241
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2009
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUSSELLVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72811-2009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-964-9119
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1808 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSSELLVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-964-9119
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2006

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: 2085R0001X , with the licence number:  MA76583 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1849627 0004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 950494 . This is a "PENNSYLVANIA BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00067988 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0014869 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010005690 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30035096 . This is a "KEYSTONE MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3371019 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 42278 . This is a "UNIVERSITY HEALTHPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60000607 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1249860 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1863592 . This is a "INDEPENDENCE BC PABS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2721771000 . This is a "KEYSTONE IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3003991 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0871205000 . This is a "AMERIHEALTH, KEYSTONE, IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6168488 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2521909 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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