1699715011 NPI number — DR. CHARLES H HILES JR. M.D.

Table of content: DR. CHARLES H HILES JR. M.D. (NPI 1699715011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699715011 NPI number — DR. CHARLES H HILES JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILES
Provider First Name:
CHARLES
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
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:
1699715011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOLFEBORO
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03894-4411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-569-7588
Provider Business Mailing Address Fax Number:
603-569-7589

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 S MAIN ST STE J
Provider Second Line Business Practice Location Address:
INTERNAL MEDICINE ASSOCIATES OF WOLFEBORO
Provider Business Practice Location Address City Name:
WOLFEBORO
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03894-4411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-569-7588
Provider Business Practice Location Address Fax Number:
603-569-7589
Provider Enumeration Date:
06/07/2006

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: 207R00000X , with the licence number:  22885 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 16224 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 005833752 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000475699 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 284099 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4275813 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1699715011 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810011077 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9693005 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 293581 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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