1275074197 NPI number — GREG MICHAEL HUCKERT C.P.O

Table of content: GREG MICHAEL HUCKERT C.P.O (NPI 1275074197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275074197 NPI number — GREG MICHAEL HUCKERT C.P.O

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUCKERT
Provider First Name:
GREG
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
C.P.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:
1275074197
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5900 COYLE AVE STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMICHAEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95608-0400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-349-7600
Provider Business Mailing Address Fax Number:
916-349-7606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5900 COYLE AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMICHAEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95608-0400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-349-7600
Provider Business Practice Location Address Fax Number:
916-349-7606
Provider Enumeration Date:
03/10/2017

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: 1744P3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CPO 02012 . This is a "AMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS, PROSTHETICS &PEDORTHICS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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