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NPI Code Detail

MEDICARE: CHARLES D HYDE FNP

MEDICARE: CHARLES D HYDE FNP
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
1363LF0000XFamily Nurse PractitionerNP576AID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NPGO0OTHERIDBC CMMC
2000010149870OTHERIDBS MVMC
3NPGN2OTHERIDBC PLMC
4000010139848OTHERIDBS PLMC
5000010139847OTHERIDBS CMMC
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7NPRN0OTHERIDBC MVMC

General Provider Information

NPI Number : 1972644250
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES D HYDE FNP
Provider Business Mailing Address
First Line : 690 N MAIN ST
Second Line :
City : MOUNT ANGEL
State : OR
Zip : 97362-9518
Country : US
Telephone Number : 503-845-2000
Fax Number : 503-845-2384
Provider Business Practice Location Address
First Line : 690 N MAIN ST
Second Line :
City : MOUNT ANGEL
State : OR
Zip : 97362-9518
Country : US
Telephone Number : 503-845-2000
Fax Number : 503-845-2384
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2007
Last Update Date : 07/06/2009

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