MEDICARE: MARILYN HUBBARD

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	372500000X	Chore Provider

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588094676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN HUBBARD

Provider Business Mailing Address
First Line	:	5110 MIDDAY DR
Second Line	:
City	:	BLACK JACK
State	:	MO
Zip	:	63033-8521
Country	:	US
Telephone Number	:	314-741-9981
Fax Number	:	314-741-9982

Provider Business Practice Location Address
First Line	:	5110 MIDDAY DR
Second Line	:
City	:	BLACK JACK
State	:	MO
Zip	:	63033-8521
Country	:	US
Telephone Number	:	314-741-9981
Fax Number	:	314-741-9982

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

Provider Enumeration Date	:	11/26/2013
Last Update Date	:	11/26/2013

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Directions to “ MARILYN HUBBARD ” Practice Location

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