Provider Demographics
NPI:1629497060
Name:EVERARD H HUGHES M.D PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:EVERARD H HUGHES M.D PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:NORTH COAST CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EVERARD
Authorized Official - Middle Name:HUDSON
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-640-1237
Mailing Address - Street 1:3798 JANES RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4753
Mailing Address - Country:US
Mailing Address - Phone:707-633-6517
Mailing Address - Fax:707-633-6518
Practice Address - Street 1:3798 JANES RD
Practice Address - Street 2:SUITE 10
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4753
Practice Address - Country:US
Practice Address - Phone:707-633-6517
Practice Address - Fax:707-633-6518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3568483261Q00000X, 261QI0500X, 261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy