Basic Information
| Provider Information | |||||||||
| NPI: | 1770561334 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUME | ||||||||
| FirstName: | LARA | ||||||||
| MiddleName: | REBECCA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 TUNNEL ROAD | ||||||||
| Address2: | ASHEVILLE VA MEDICAL CENTER | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282987911 | ||||||||
| FaxNumber: | 8282964425 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 TUNNEL ROAD | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288057911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282987911 | ||||||||
| FaxNumber: | 8282964425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 06/03/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 9901548 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 030455058 | 01 | CRESENT | OTHER | 12586 | 01 | NC | BCBS | OTHER | 8912486 | 05 | NC | MEDICAID | 5435417002 | 01 | CIGNA HEALTHCARE | OTHER | N01549 | 05 | SC | MEDICAID | 110245214 | 01 | RR MEDICARE | OTHER | 030455058 | 01 | HEALTHCARE SAVINGS | OTHER | 0401746 | 01 | UNITED HEALTHCARE | OTHER | VAD000 | 01 | VA UPIN | OTHER | C3416 | 01 | MEDCOST | OTHER |