1689874836 NPI number — JONATHAN D HYMAN DPM A PROFESSIONAL CORPORATION

Table of content: (NPI 1689874836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689874836 NPI number — JONATHAN D HYMAN DPM A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JONATHAN D HYMAN DPM A PROFESSIONAL CORPORATION
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:
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:
1689874836
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5959 WEST LOOP S
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
BELLAIRE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77401-2421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-666-9934
Provider Business Mailing Address Fax Number:
713-666-8659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5959 WEST LOOP S
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
BELLAIRE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77401-2421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-666-9934
Provider Business Practice Location Address Fax Number:
713-666-8659
Provider Enumeration Date:
07/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HYMAN
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PODIATRY
Authorized Official Telephone Number:
713-666-9934

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  0387 , 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: 480004754 . This is a "MEDICARE RRB" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: IDEC2526069 . This is a "ACED" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TX9999 . This is a "MUTUAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 119889702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: T13988 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 77096 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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