Provider Demographics
NPI:1881840890
Name:HAUTER MEDICAL, LLC
Entity Type:Organization
Organization Name:HAUTER MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-216-3350
Mailing Address - Street 1:1679 INDIAN ROCKS RD S BLDG B
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-1026
Mailing Address - Country:US
Mailing Address - Phone:727-216-3350
Mailing Address - Fax:727-216-3340
Practice Address - Street 1:1679 INDIAN ROCKS RD S BLDG B
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-1026
Practice Address - Country:US
Practice Address - Phone:727-216-3350
Practice Address - Fax:727-216-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-10
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6217720001Medicare NSC