1316116742 NPI number — DR. BELINDA LEWIS HUBERT PHD

Table of content: DR. BELINDA LEWIS HUBERT PHD (NPI 1316116742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316116742 NPI number — DR. BELINDA LEWIS HUBERT PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUBERT
Provider First Name:
BELINDA
Provider Middle Name:
LEWIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUBERT
Provider Other First Name:
BELINDA
Provider Other Middle Name:
LEWIS
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1316116742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17317 WHITE OAK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOWELL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46356-9411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-696-2859
Provider Business Mailing Address Fax Number:
219-696-1745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17317 WHITE OAK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOWELL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46356-9411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-696-2859
Provider Business Practice Location Address Fax Number:
219-696-1745
Provider Enumeration Date:
02/29/2008

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: 103TC0700X , with the licence number:  HSPP 20040912 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10465150A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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