Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | J1268 | TX |
NPI | 1063435915 |
---|---|
Provider Name | Andrew Hume |
First Address | San Angelo, TX 76902-7200 |
Second Address | San Angelo, TX 76903-5400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 18/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
115391802 | (05) | TX |
741796484 | TAX ID NO (01) | TX |
827040 | AUSTIN BCBS PROVIDER NO (01) | TX |
82Z040 | BCBS AUSTIN ID NUMBER (01) | TX |
82Z040 | MEDICARE AUSTIN ID NUMBER (01) | TX |
85007X | BCBS SAN ANGELO ID NUMBER (01) | TX |
85007X | SAN ANGELO BCBS PROV NO (01) | TX |
F65068 | (02) | TX |