1801844709 NPI number — WILLIAM C HULLEY III DO

Table of content: WILLIAM C HULLEY III DO (NPI 1801844709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801844709 NPI number — WILLIAM C HULLEY III DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HULLEY
Provider First Name:
WILLIAM
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
DO
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:
1801844709
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
670 CLEARWATER LARGO RD N
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33770-2377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-446-8226
Provider Business Mailing Address Fax Number:
727-446-8216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
670 CLEARWATER LARGO RD N
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33770-2377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-446-8226
Provider Business Practice Location Address Fax Number:
727-446-8216
Provider Enumeration Date:
05/04/2006

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: 2084N0400X , with the licence number:  OS3664 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 057792800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 591759586 . This is a "TAX ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 111830900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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