Healthcare Provider Details

I. General information

NPI: 1811933096
Provider Name (Legal Business Name): JOSEPH JUAN HUBBARD RN 71422
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC EVANS COMMUNITY HOSPITAL PACU SDS PADM
FT CARSON CO
80913-4603
US

IV. Provider business mailing address

2500 BROAD ST
CAMDEN SC
29020-2225
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7015
  • Fax: 719-526-7019
Mailing address:
  • Phone: 803-432-5103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN174865
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number71422
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71422
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: