Provider Demographics
NPI:1124381538
Name:HIRST, CHARLES BRADLEY (PAC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:BRADLEY
Last Name:HIRST
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:WEBSTER CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50595-0430
Mailing Address - Country:US
Mailing Address - Phone:515-832-9400
Mailing Address - Fax:515-832-9494
Practice Address - Street 1:2350 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595-6600
Practice Address - Country:US
Practice Address - Phone:515-832-9400
Practice Address - Fax:515-832-9494
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01785363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant