1124016746 NPI number — DR. LARRY D HIRSCHY DC

Table of content: DR. LARRY D HIRSCHY DC (NPI 1124016746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124016746 NPI number — DR. LARRY D HIRSCHY DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HIRSCHY
Provider First Name:
LARRY
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1124016746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 LINDEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARITON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50049-1835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-774-4018
Provider Business Mailing Address Fax Number:
641-774-7570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 LINDEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARITON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50049-1835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-774-9018
Provider Business Practice Location Address Fax Number:
641-774-7570
Provider Enumeration Date:
10/07/2005

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: 111N00000X , with the licence number:  04363 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111NX0800X , with the licence number: 04363 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0130773 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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