Provider Demographics
NPI:1972720365
Name:CHARLES H. HUBER, M.D.
Entity type:Organization
Organization Name:CHARLES H. HUBER, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-419-1109
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:KY
Mailing Address - Zip Code:40026-0236
Mailing Address - Country:US
Mailing Address - Phone:502-419-1109
Mailing Address - Fax:502-222-6116
Practice Address - Street 1:3901 GREENHAVEN LN
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:KY
Practice Address - Zip Code:40026-8755
Practice Address - Country:US
Practice Address - Phone:502-419-1109
Practice Address - Fax:502-222-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY151384207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1049936OtherPASSPORT PROVIDER NUMBER
KY000000045756OtherANTHEM PROVIDER NUMBER
KY0700276OtherUHC PROVIDER NUMBER
KY=========OtherTAX ID
KS1146901Medicare ID - Type UnspecifiedMEDICARE ID