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General NPI Number Information
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NPI Number | 1528309267
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Entity Type | Individual
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Provider Name | JACK J HUGHES III COTA
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Gender | Male
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 1850 W MATADOR ST
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City | PERU
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State | IN
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Zip | 46970-3711
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Country | US
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Telephone | 765-689-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 4476 N 622 W
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City | HUNTINGTON
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State | IN
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Zip | 46750-8984
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Country | US
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Telephone | 260-358-8827
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Fax |
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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 | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 32002213A
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License Number State | IN
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