Provider Demographics
NPI:1285803163
Name:HUGHES, MIRIAM ANN (RPT)
Entity type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:ANN
Last Name:HUGHES
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 9TH ST
Mailing Address - Street 2:EUREKA COMMUNITY HEALTH SERVICES
Mailing Address - City:EUREKA
Mailing Address - State:SD
Mailing Address - Zip Code:57437-2182
Mailing Address - Country:US
Mailing Address - Phone:605-284-2661
Mailing Address - Fax:605-284-2054
Practice Address - Street 1:410 9TH ST
Practice Address - Street 2:EUREKA COMMUNITY HEALTH SERVICES
Practice Address - City:EUREKA
Practice Address - State:SD
Practice Address - Zip Code:57437-2182
Practice Address - Country:US
Practice Address - Phone:605-284-2661
Practice Address - Fax:605-284-2054
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0185225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9571960Medicaid
SD9571960Medicaid