1740356526 NPI number — MR. PATRICK W HICKEY P.A.

Table of content: MR. PATRICK W HICKEY P.A. (NPI 1740356526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740356526 NPI number — MR. PATRICK W HICKEY P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HICKEY
Provider First Name:
PATRICK
Provider Middle Name:
W
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.A.
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:
1740356526
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 JOHN PAUL JONES CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-953-5008
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
243 CURTISS ROAD, SUITE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARKSDALE AFB
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71110-2425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-456-5059
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/25/2006

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: 363A00000X , with the licence number:  1097209 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 0110004808 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1710I1002X . This is a "INDEPENDANT DUTY CORPSMAN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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