1154424000 NPI number — DAVID HYLER-BOTH D. O.

Table of content: DAVID HYLER-BOTH D. O. (NPI 1154424000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154424000 NPI number — DAVID HYLER-BOTH D. O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HYLER-BOTH
Provider First Name:
DAVID
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D. O.
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:
1154424000
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1049
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24901-4049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-645-4043
Provider Business Mailing Address Fax Number:
304-645-4713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
163 GREENBRIER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUPERT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-717-0070
Provider Business Practice Location Address Fax Number:
304-717-0072
Provider Enumeration Date:
09/06/2006

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: 204D00000X , with the licence number:  1073 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 1073 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001371982 . This is a "BC/BS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 288222 . This is a "ONE NET" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 888222 . This is a "OPTIMUM CHOICE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 4458347 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1014329 . This is a "BRICKSTREET" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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