1952305294 NPI number — DR. STEVEN W HILDEBRAND MD, FACC

Table of content: DR. STEVEN W HILDEBRAND MD, FACC (NPI 1952305294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952305294 NPI number — DR. STEVEN W HILDEBRAND MD, FACC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILDEBRAND
Provider First Name:
STEVEN
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, FACC
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:
1952305294
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDLANDS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92373-0722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-845-0313
Provider Business Mailing Address Fax Number:
951-845-8194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6109 W RAMSEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANNING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92220-3051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-845-0313
Provider Business Practice Location Address Fax Number:
951-845-8194
Provider Enumeration Date:
06/01/2005

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: 207RC0000X , with the licence number:  9500937 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0227U . This is a "BCBS NC GROUP ID #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 582333928 . This is a "NC TAX ID USED BY INS COS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: NPA709 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42353 . This is a "BCBS NC INDIVIDUAL ID #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890227U , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8942353 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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