Basic Information
Provider Information | |||||||||
NPI: | 1497088645 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HILTON | ||||||||
FirstName: | TODD | ||||||||
MiddleName: | DAVID | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 47 RASES MOUNTAIN DR | ||||||||
Address2: |   | ||||||||
City: | MINFORD | ||||||||
State: | OH | ||||||||
PostalCode: | 456539600 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7408205747 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 272 HOSPITAL RD | ||||||||
Address2: |   | ||||||||
City: | CHILLICOTHE | ||||||||
State: | OH | ||||||||
PostalCode: | 456019031 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7407797540 | ||||||||
FaxNumber: | 7407797867 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/04/2009 | ||||||||
LastUpdateDate: | 11/30/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/30/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN262499 | OH | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   | 367500000X | 58256 | WV | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
No ID Information.