Basic Information
| Provider Information | |||||||||
| NPI: | 1366479248 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HURT | ||||||||
| FirstName: | BUDDY | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 1680 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257171680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046971396 | ||||||||
| FaxNumber: | 3046972086 | ||||||||
| Practice Location | |||||||||
| Address1: | 22 FLEMING DRIVE | ||||||||
| Address2: | |||||||||
| City: | HARTS | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048554595 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 05/29/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2177 | WV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2662604 | 05 | OH | MEDICAID | 64001886 | 05 | KY | MEDICAID | 00326306 | 01 | WV | RR MEDICARE | OTHER | 3810005690 | 05 | WV | MEDICAID |