Basic Information
| Provider Information | |||||||||
| NPI: | 1245778174 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HUGHSTON CLINIC PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6262 VETERANS PKWY | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319093540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064943071 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8400 RED BUG LAKE RD | ||||||||
| Address2: | SUITE 2090 | ||||||||
| City: | OVIEDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327656828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064943071 | ||||||||
| FaxNumber: | 7064943201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2017 | ||||||||
| LastUpdateDate: | 04/03/2017 | ||||||||
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| AuthorizedOfficialLastName: | BENCHWICH | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 7064943071 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | FL | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.