MEDICARE: JEREMIAH MICHAEL HAMMETT PRSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	21-948	WV

General Provider Information

NPI Number	:	1235840687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMIAH MICHAEL HAMMETT PRSS

Provider Business Mailing Address
First Line	:	343 5TH AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-1811
Country	:	US
Telephone Number	:	304-894-4515
Fax Number	:

Provider Business Practice Location Address
First Line	:	1236 5TH AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-2207
Country	:	US
Telephone Number	:	681-204-5400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2022
Last Update Date	:	09/24/2024

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