Provider Demographics
NPI:1609914308
Name:HUMMER FAMILY PRACTICE, INC.
Entity Type:Organization
Organization Name:HUMMER FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-637-2410
Mailing Address - Street 1:19 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3125
Mailing Address - Country:US
Mailing Address - Phone:304-637-2410
Mailing Address - Fax:304-637-2419
Practice Address - Street 1:19 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3125
Practice Address - Country:US
Practice Address - Phone:304-637-2410
Practice Address - Fax:304-637-2419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006386Medicaid
F31394Medicare UPIN
WV3810006386Medicaid
9271411Medicare ID - Type Unspecified