1740227180 NPI number — SEBASTIAN O. HUBBUCH III M.D.

Table of content: (NPI 1740227180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740227180 NPI number — SEBASTIAN O. HUBBUCH III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEBASTIAN O. HUBBUCH III M.D.
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:
CHATTAHOOCHEE VALLEY CARDIOLOGY M.D., P.C.
Provider Other Organization Name Type Code:
3
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:
1740227180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8709
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31908-8709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-565-7382
Provider Business Mailing Address Fax Number:
706-565-9110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3808 GENTIAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31907-1147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-565-7382
Provider Business Practice Location Address Fax Number:
706-565-9110
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUBBUCH
Authorized Official First Name:
SEBASTIAN
Authorized Official Middle Name:
O.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
706-565-7382

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00390684F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1811994403 . This is a "NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 5229902570 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009934586 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1477752863 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1841297728 . This is a "NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 353912753A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 721581511A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009911240 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1477752863 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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