1609879824 NPI number — DR. ROBERT L HUME DPM

Table of content: DR. ROBERT L HUME DPM (NPI 1609879824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609879824 NPI number — DR. ROBERT L HUME DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUME
Provider First Name:
ROBERT
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1609879824
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 N 10TH ST W
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
ALTOONA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54720-2639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-832-1400
Provider Business Mailing Address Fax Number:
715-832-4187

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 N 10TH ST W
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54720-2639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-832-1400
Provider Business Practice Location Address Fax Number:
715-832-4187
Provider Enumeration Date:
05/23/2005

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: 213ES0131X , with the licence number:  436-025 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 391359900019 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 791480582 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43211400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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