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General NPI Number Information
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NPI Number | 1174837637
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Entity Type | Individual
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Provider Name | JAMIE C. HUBBARD CSA
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Gender | Male
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 04/17/2019
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Provider Practice Location Address
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Address Line | 1023 NEW MOODY LN SUITE 102
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City | LA GRANGE
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State | KY
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Zip | 40031-9177
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Country | US
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Telephone | 502-222-0598
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Fax | 502-222-7446
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Provider Business Mailing Address
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Address Line | PO BOX 950248
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City | LOUISVILLE
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State | KY
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Zip | 40295-0248
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Country | US
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Telephone | 502-253-1035
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Fax | 502-253-1037
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | 3525
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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