Provider Demographics
NPI:1316071095
Name:HURRICANE FAMILY PRACTICE, PC
Entity type:Organization
Organization Name:HURRICANE FAMILY PRACTICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-635-9444
Mailing Address - Street 1:11 SOUTH MAIN
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-1949
Mailing Address - Country:US
Mailing Address - Phone:435-635-9444
Mailing Address - Fax:435-635-8148
Practice Address - Street 1:11 SOUTH MAIN
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-1949
Practice Address - Country:US
Practice Address - Phone:435-635-9444
Practice Address - Fax:435-635-8148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT463814Medicare Oscar/Certification