Provider Demographics
NPI:1326129123
Name:HULETT, SAM P (PA-C)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:P
Last Name:HULETT
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:6905 HOSPITAL DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9600
Mailing Address - Country:US
Mailing Address - Phone:614-923-0300
Mailing Address - Fax:614-923-0400
Practice Address - Street 1:6905 HOSPITAL DR
Practice Address - Street 2:SUITE 130
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9600
Practice Address - Country:US
Practice Address - Phone:614-923-0300
Practice Address - Fax:614-923-0400
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2017-01-25
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0151543Medicaid
OHH310850Medicare PIN