Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 16790 | KY |
NPI | 1003810797 |
---|---|
Provider Name | Steve Hiland |
First Address | Eddyville, KY 42038-0763 |
Second Address | Eddyville, KY 42038-7386 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000045633 | ANTHEM BCBS (01) | KY |
012587032 | RAILROAD MEDICARE (01) | KY |
64167901 | (05) | KY |
C64614 | (02) | KY |