Healthcare Provider Details

I. General information

NPI: 1316329154
Provider Name (Legal Business Name): SAMUEL HUGHES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2015
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 NORTHSTAR DR
HOLTS SUMMIT MO
65043-1123
US

IV. Provider business mailing address

PO BOX 1027
JEFFERSON CITY MO
65102-1027
US

V. Phone/Fax

Practice location:
  • Phone: 573-896-8301
  • Fax: 573-896-8589
Mailing address:
  • Phone: 573-681-3767
  • Fax: 573-681-3593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7583
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2023008393
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: