Provider Demographics
NPI:1740437839
Name:RONALD C. HUBBARD SR., M.D. APMC
Entity type:Organization
Organization Name:RONALD C. HUBBARD SR., M.D. APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:D
Authorized Official - Last Name:TIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-340-9600
Mailing Address - Street 1:3510 MAGNOLIA CV STE 180
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2370
Mailing Address - Country:US
Mailing Address - Phone:318-340-9600
Mailing Address - Fax:318-340-9675
Practice Address - Street 1:3510 MAGNOLIA CV STE 180
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2370
Practice Address - Country:US
Practice Address - Phone:318-340-9600
Practice Address - Fax:318-340-9675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018486302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA54549OtherMEDICARE
LA1377058Medicaid
LA1377058Medicaid