1447211040 NPI number — DR. RANDALL JAMES HILL MD

Table of content: DR. RANDALL JAMES HILL MD (NPI 1447211040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447211040 NPI number — DR. RANDALL JAMES HILL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILL
Provider First Name:
RANDALL
Provider Middle Name:
JAMES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1447211040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
830 PENNSYLVANIA AVE
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25302-3302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-346-4455
Provider Business Mailing Address Fax Number:
304-346-4457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
830 PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25302-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-346-4455
Provider Business Practice Location Address Fax Number:
304-346-4457
Provider Enumeration Date:
03/31/2006

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: 207V00000X , with the licence number:  13989 , 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: 408466 . This is a "CARELINK COMMERCIAL" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 37213 . This is a "CARELINK MEDICAID" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 4245376 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 925491 . This is a "MAMSI" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001794375 . This is a "BCBS PIN#" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 000687821 . This is a "BCBS INDIVIDUAL ID" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 11101421 . This is a "CAQH" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810004470 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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