1316319163 NPI number — MR. BILL CHANIN HUBBS AGACNP

Table of content: MR. BILL CHANIN HUBBS AGACNP (NPI 1316319163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316319163 NPI number — MR. BILL CHANIN HUBBS AGACNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUBBS
Provider First Name:
BILL
Provider Middle Name:
CHANIN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
AGACNP
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:
1316319163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8300 N LAMAR BLVD
Provider Second Line Business Mailing Address:
STE 200A
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78753-5976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-782-9312
Provider Business Mailing Address Fax Number:
512-782-9316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 W SOUTHLAKE BLVD
Provider Second Line Business Practice Location Address:
STE #120
Provider Business Practice Location Address City Name:
SOUTHLAKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76092-5950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-416-6116
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2015

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: 363LA2100X , with the licence number:  AP129184 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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