Provider Demographics
NPI:1508534777
Name:HICKS, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:HICKS
Suffix:
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:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:COAL CITY
Mailing Address - State:WV
Mailing Address - Zip Code:25823-0023
Mailing Address - Country:US
Mailing Address - Phone:304-763-6362
Mailing Address - Fax:
Practice Address - Street 1:240 PARKER ST
Practice Address - Street 2:
Practice Address - City:COAL CITY
Practice Address - State:WV
Practice Address - Zip Code:25823
Practice Address - Country:US
Practice Address - Phone:304-763-6362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant