Provider Demographics
NPI:1962413674
Name:CARL W. HUFF, MD, PC
Entity type:Organization
Organization Name:CARL W. HUFF, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-587-5359
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-0148
Mailing Address - Country:US
Mailing Address - Phone:731-587-5359
Mailing Address - Fax:
Practice Address - Street 1:1855 HWY 51 BYPASS
Practice Address - Street 2:SUITE B
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1855
Practice Address - Country:US
Practice Address - Phone:731-285-1585
Practice Address - Fax:731-285-1492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD006673207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3388340Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER N
TN3388340Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
TN1081070001Medicare NSC