1902897234 NPI number — DR. LARRY WAYNE HAMBERLIN D.C., PH.D, NP-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902897234 NPI number — DR. LARRY WAYNE HAMBERLIN D.C., PH.D, NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMBERLIN
Provider First Name:
LARRY
Provider Middle Name:
WAYNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C., PH.D, NP-C
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:
1902897234
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1866
Provider Second Line Business Mailing Address:
809 W. NASH, STE. A
Provider Business Mailing Address City Name:
TERRELL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75160-0033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-563-1475
Provider Business Mailing Address Fax Number:
972-524-5132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
809 W NASH ST
Provider Second Line Business Practice Location Address:
STE. A
Provider Business Practice Location Address City Name:
TERRELL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75160-2557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-563-1475
Provider Business Practice Location Address Fax Number:
972-524-5132
Provider Enumeration Date:
11/04/2005

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: 363LF0000X , with the licence number:  774755 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 8248 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0020836-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1959676 . This is a "FIRST HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 21206450531-01 . This is a "BEECHSTREET" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7616077 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10030732 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0059145 . This is a "BLUELINK" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 13877 . This is a "PARKLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 89705 . This is a "AMERICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 432141 . This is a "ASHN" identifier . This identifiers is of the category "OTHER".




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