1326356122 NPI number — MICHAEL T MCHUGH DDS

Table of content: MICHAEL T MCHUGH DDS (NPI 1326356122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326356122 NPI number — MICHAEL T MCHUGH DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCHUGH
Provider First Name:
MICHAEL
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1326356122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1246 YELLOWSTONE AVE
Provider Second Line Business Mailing Address:
STE D3
Provider Business Mailing Address City Name:
POCATELLO
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83201-4374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-238-0125
Provider Business Mailing Address Fax Number:
208-478-2200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1246 YELLOWSTONE AVE
Provider Second Line Business Practice Location Address:
STE D3
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83201-4374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-238-0125
Provider Business Practice Location Address Fax Number:
208-478-2200
Provider Enumeration Date:
09/15/2010

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: 1223G0001X , with the licence number:  D1755 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6P591 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 9201894 . This is a "IDAHO SMILES/DENTAQUEST" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010009646 . This is a "BLUE SHIELD OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 612058100 . This is a "US DEPARTMENT OF LABOR" identifier . This identifiers is of the category "OTHER".




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