Provider Demographics
NPI:1841510799
Name:HUEY R KIDD DO PC
Entity type:Organization
Organization Name:HUEY R KIDD DO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HUEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:334-636-4823
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:AL
Mailing Address - Zip Code:36446-0065
Mailing Address - Country:US
Mailing Address - Phone:334-636-4823
Mailing Address - Fax:334-636-1702
Practice Address - Street 1:218 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:AL
Practice Address - Zip Code:36446
Practice Address - Country:US
Practice Address - Phone:334-636-4823
Practice Address - Fax:334-636-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL013954Medicare Oscar/Certification