1649361205 NPI number — ANITA J HUBER D.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649361205 NPI number — ANITA J HUBER D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUBER
Provider First Name:
ANITA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1649361205
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1420 BUS. HWY. 61 SOUTH
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
BOWLING GREEN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-324-6012
Provider Business Mailing Address Fax Number:
573-324-6014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1420 BUS. HWY. 61 SOUTH
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
BOWLING GREEN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-324-6012
Provider Business Practice Location Address Fax Number:
573-324-6014
Provider Enumeration Date:
09/27/2006

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: 111N00000X , with the licence number:  2001006912 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 144836 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 466698 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 617979 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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