1841220746 NPI number — IAN HAYCOCKS MD

Table of content: IAN HAYCOCKS MD (NPI 1841220746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841220746 NPI number — IAN HAYCOCKS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAYCOCKS
Provider First Name:
IAN
Provider Middle Name:
Provider Name Prefix Text:
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:
1841220746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 REMITTANCE DR DEPT 8310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60675-8310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-444-1919
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40391-9591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-230-8200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/04/2006

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: 2085R0202X , with the licence number:  10797 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100502691 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01168988 . This is a "RR MEDICARE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 200469350A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1841220746 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100475330 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com