=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336967876
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN THOMAS HILL III LVN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2024
-----------------------------------------------------
Last Update Date | 10/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9939 STATE HIGHWAY 151
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78251-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-706-7951
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8400 W FM 140
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78011-3517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-365-1426
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 303795
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------