1639170954 NPI number — DR. IVAGENE P. HULTS DC, CICE

Table of content: DR. IVAGENE P. HULTS DC, CICE (NPI 1639170954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639170954 NPI number — DR. IVAGENE P. HULTS DC, CICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HULTS
Provider First Name:
IVAGENE
Provider Middle Name:
P.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC, CICE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HULTS
Provider Other First Name:
GENIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1639170954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7250 DINGO CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89119-4556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-245-6090
Provider Business Mailing Address Fax Number:
702-269-7078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2250 E TROPICANA AVE
Provider Second Line Business Practice Location Address:
#3
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89119-6541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-245-6090
Provider Business Practice Location Address Fax Number:
702-269-7078
Provider Enumeration Date:
08/09/2005

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: 111NX0100X , with the licence number:  B00470 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 865091 . This is a "USA MANAGED CARE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: B00470 . This is a "DC LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 1006922 . This is a "FOCUS HEALTHCARE MGT." identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 737260 . This is a "FIRSTS HEALTH" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: P-65814852 . This is a "MULTIPLAN, INC." identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 18825 . This is a "DC LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 9156671 . This is a "PHCS" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: NVIPH-HCR . This is a "EDI SUBMITTER ID FOR IVA" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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