Basic Information
| Provider Information | |||||||||
| NPI: | 1174614895 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUNTWORK | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | CHURCHILL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4211 HOSPITAL ST | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | PASCAGOULA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395815320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2286969995 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4211 HOSPITAL ST | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | PASCAGOULA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395815320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2286969995 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 03/24/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 15215 | MS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 00117902 | 05 | MS | MEDICAID |