MEDICARE: DR. EDWARD A HUBACH D.O.

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	207Q00000X	Family Medicine Physician	34002371H	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	080191719	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	220226705	OTHER	OH	DEPT. OF LABOR WC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	D0237103	OTHER	OH	HUMANA/CHOICECARE
5	635756	OTHER	OH	AETNA
6	0120089	OTHER	OH	UNITED HEALTHCARE
7	34002371	OTHER	OH	MEDICAL LICENSE
8	421534506094	OTHER	OH	CARESOURCE
9	000000227899	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1821091331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD A HUBACH D.O.

Provider Business Mailing Address
First Line	:	2912 SPRINGBORO W
Second Line	:	STE 201
City	:	DAYTON
State	:	OH
Zip	:	45439-1674
Country	:	US
Telephone Number	:	937-297-8999
Fax Number	:	937-297-4852

Provider Business Practice Location Address
First Line	:	6255 CHAMBERSBURG ROAD
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424
Country	:	US
Telephone Number	:	937-233-7141
Fax Number	:	937-233-1956

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

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	08/29/2018

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Directions to “ DR. EDWARD A HUBACH D.O.” Practice Location

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