Basic Information
| Provider Information | |||||||||
| NPI: | 1063498343 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HYDE | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | EDMUND | ||||||||
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| Credential: | M.D., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 N. MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | RUSHVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7659324111 | ||||||||
| FaxNumber: | 7659327065 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 E. 13TH STREET | ||||||||
| Address2: | |||||||||
| City: | RUSHVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7659327063 | ||||||||
| FaxNumber: | 7659327065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 11/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | M0115 | TX | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207YS0012X | 01082170A | IN | N | Allopathic & Osteopathic Physicians | Otolaryngology | Sleep Medicine | 207YS0012X | M0115 | TX | N | Allopathic & Osteopathic Physicians | Otolaryngology | Sleep Medicine | 207YX0602X | 01082170A | IN | N | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngic Allergy | 207YX0602X | M0115 | TX | N | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngic Allergy | 207Y00000X | 01082170A | IN | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | P00234692 | 01 | RAILROAD MEDICARE | OTHER | 182063102 | 05 | TX | MEDICAID |