Provider Demographics
NPI:1184831513
Name:HUGHES, PHILLIP RAY SR
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:RAY
Last Name:HUGHES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 PAULINE MILLER RD
Mailing Address - Street 2:
Mailing Address - City:PEEBLES
Mailing Address - State:OH
Mailing Address - Zip Code:45660-9192
Mailing Address - Country:US
Mailing Address - Phone:937-587-2510
Mailing Address - Fax:
Practice Address - Street 1:62 PAULINE MILLER RD
Practice Address - Street 2:
Practice Address - City:PEEBLES
Practice Address - State:OH
Practice Address - Zip Code:45660-9192
Practice Address - Country:US
Practice Address - Phone:937-587-2510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2460153Medicaid