Provider Demographics
NPI:1023069085
Name:QUEVEDO, HUGO F (PA-C)
Entity type:Individual
Prefix:MR
First Name:HUGO
Middle Name:F
Last Name:QUEVEDO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LCMC HEALTH - PAYOR ENROLLMENTS
Mailing Address - Street 2:1100 POYDRAS ST., STE. 2500
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70163-2500
Mailing Address - Country:US
Mailing Address - Phone:504-527-9953
Mailing Address - Fax:
Practice Address - Street 1:101 JUDGE TANNER BLVD STE 300
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7506
Practice Address - Country:US
Practice Address - Phone:859-867-2100
Practice Address - Fax:985-871-1548
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03001363A00000X
FLPA9101747363A00000X, 363AM0700X, 363AS0400X
TXPA09186363A00000X
LA340264363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341839406Medicaid
TXP02028479OtherMEDICARE RAIL ROAD
NC8102414Medicaid
LA6L3985OtherMEDICARE
TX647908OtherMEDICARE
NCNC1699IMedicare PIN
NCNC1699LMedicare PIN
NCNC1699DMedicare PIN
NCNC1699KMedicare PIN
NCNC1699GMedicare PIN
NCNC1699PMedicare PIN
NCNC1699CMedicare PIN
NCNC1699MMedicare PIN
NCNC1699NMedicare PIN
FLP54195Medicare UPIN
NCNC1699FMedicare PIN
FLE7140BMedicare ID - Type Unspecified
NCNC1699JMedicare PIN