1407859341 NPI number — PAULA ANN HICKS M.D.

Table of content: GARY KANTER M.D. (NPI 1952391682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407859341 NPI number — PAULA ANN HICKS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HICKS
Provider First Name:
PAULA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1407859341
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 819
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YANKTON
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57078-0819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-665-9638
Provider Business Mailing Address Fax Number:
605-665-0526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 W 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YANKTON
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57078-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-665-9638
Provider Business Practice Location Address Fax Number:
605-665-0526
Provider Enumeration Date:
05/24/2005

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: 207W00000X , with the licence number:  3820 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , with the licence number: 19498 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 22053 . This is a "NE BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 36-3050195-13 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: NA1114001 . This is a "NE MEDICARE PTAN NORFOLK, NE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 36-3050195-14 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3820 . This is a "DAKOTACARE PROVIDER ID" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 6300100 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0003388 . This is a "SD WELLMARK BLUE SHIELD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: NA1115001 . This is a "NE MEDICARE PTAN WAYNE, NE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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