1063507754 NPI number — MR. WARREN W HUGHES MSPT

Table of content: MR. WARREN W HUGHES MSPT (NPI 1063507754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063507754 NPI number — MR. WARREN W HUGHES MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUGHES
Provider First Name:
WARREN
Provider Middle Name:
W
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSPT
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:
1063507754
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
78 BEECHLAND ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLSWORTH
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-667-4800
Provider Business Mailing Address Fax Number:
207-667-5600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
78 BEECHLAND ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLSWORTH
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-667-4800
Provider Business Practice Location Address Fax Number:
207-667-5600
Provider Enumeration Date:
10/04/2006

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: 225100000X , with the licence number:  PT2544 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1063507754 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1063507754 . This is a "CIGNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1063507754 . This is a "TRICARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1063507754 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1063507754 . This is a "MEDICARE RAILROAD CARRIER" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1063507754 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1063507754 . This is a "ANTHEM BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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