Basic Information
| Provider Information | |||||||||
| NPI: | 1437791266 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HCC OF HUGO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 222006 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752222006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669318882 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 6TH ST | ||||||||
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| City: | HUGO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 808212002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669318882 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2019 | ||||||||
| LastUpdateDate: | 10/14/2019 | ||||||||
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| AuthorizedOfficialLastName: | WEISS | ||||||||
| AuthorizedOfficialFirstName: | RON | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8669318882 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.