Active NPI
Eddie C Hubbard
- Community Health Worker
- Milton, FL
National Provider Identifier
1053673145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- CNA27456
- Practice address
- 7511 John Matthews Rd
Milton, FL 32583-3401 - Phone
- (850) 516-3039
- Fax
- (850) 623-1181
- NPI assigned
- Jun 13, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | CNA27456 | FL | Primary |
Addresses
Primary practice location
7511 John Matthews Rd
Milton, FL 32583-3401
Mailing address
7511 John Matthews Rd
Milton, FL 32583-3401
Phone (850) 516-3039
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 673797879 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CNA27456 | FL | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339545600000",
"number": "1053673145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7511 JOHN MATTHEWS RD",
"city": "MILTON",
"state": "FL",
"postal_code": "325833401",
"telephone_number": "850-516-3039",
"fax_number": "850-623-1181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7511 JOHN MATTHEWS RD",
"city": "MILTON",
"state": "FL",
"postal_code": "325833401",
"telephone_number": "850-516-3039",
"fax_number": "850-623-1181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUBBARD",
"first_name": "EDDIE",
"middle_name": "C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-13",
"last_updated": "2012-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "FL",
"license": "CNA27456",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "673797879",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milton, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.