Basic Information
| Provider Information | |||||||||
| NPI: | 1619927241 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUGHES | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2009 | ||||||||
| Address2: | |||||||||
| City: | RUSSELLVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 728112009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4799649119 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1808 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RUSSELLVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4799649119 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 09/04/2018 | ||||||||
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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 | 2085R0001X | MA76583 | NJ | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1849627 0004 | 05 | PA | MEDICAID | 950494 | 01 | PENNSYLVANIA BLUE SHIELD | OTHER | P00067988 | 01 | RR MEDICARE | OTHER | 0014869 | 05 | NJ | MEDICAID | 010005690 | 01 | AMERICHOICE | OTHER | 30035096 | 01 | KEYSTONE MERCY | OTHER | 3371019 | 01 | NJ | AETNA | OTHER | 42278 | 01 | UNIVERSITY HEALTHPLAN | OTHER | 60000607 | 01 | HORIZON NJ HEALTH | OTHER | 1249860 | 01 | PA | AETNA | OTHER | 1863592 | 01 | INDEPENDENCE BC PABS | OTHER | 2721771000 | 01 | KEYSTONE IBC | OTHER | P3003991 | 01 | NJ | OXFORD | OTHER | 0871205000 | 01 | AMERIHEALTH, KEYSTONE, IBC | OTHER | 6168488 | 01 | CIGNA | OTHER | 2521909 | 01 | UNITED HEALTHCARE | OTHER |