1821100827 NPI number — DR. CARL A HICKS MD

Table of content: DR. CARL A HICKS MD (NPI 1821100827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821100827 NPI number — DR. CARL A HICKS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HICKS
Provider First Name:
CARL
Provider Middle Name:
A
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:
1821100827
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16811 SOUTHWEST FWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-4728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-690-4678
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16811 SOUTHWEST FWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77479-4728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-690-4678
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2006

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: 207X00000X , with the licence number:  H3576 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 104542901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104542908 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104542904 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104542905 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01055718 . This is a "RR MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 687360 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8BP178 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00732733 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 610119705 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 104542906 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104542903 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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