MEDICARE: ROGER W HURLBUT JR. NP

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	363LF0000X	Family Nurse Practitioner	71002460A	IN
2	363LP2300X	Primary Care Nurse Practitioner	71002460A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00631303	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000532575	OTHER	IN	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	CA5604	OTHER	IN	MCR RAILROAD GROUP

General Provider Information

NPI Number	:	1932393188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER W HURLBUT JR. NP

Provider Business Mailing Address
First Line	:	5026 W US 52
Second Line	:
City	:	NEW PALESTINE
State	:	IN
Zip	:	46163-9770
Country	:	US
Telephone Number	:	317-861-4838
Fax Number	:

Provider Business Practice Location Address
First Line	:	5026 W US 52
Second Line	:
City	:	NEW PALESTINE
State	:	IN
Zip	:	46163-9770
Country	:	US
Telephone Number	:	317-861-4838
Fax Number	:

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

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	07/09/2019

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