Individual provider Active NPI

Hugh Randall Latham, PA

  • Surgical Physician Assistant
  • Tuscaloosa, AL
National Provider Identifier
1093759805
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA-137 Issued in AL
Practice address
305 Paul Bryant Dr E
Tuscaloosa, AL 35401-2094
Phone
(205) 345-0192
Fax
(205) 247-2194
NPI assigned
Jun 15, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA-137 AL Primary

Addresses

Primary practice location

305 Paul Bryant Dr E
Tuscaloosa, AL 35401-2094

Mailing address

305 Paul Bryant Dr E
Tuscaloosa, AL 35401-2094
Phone (205) 345-0192

Other identifiers 1

IdentifierTypeStateIssuer
51042288OtherALBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101203000643 AL Practitioner - Physician Assistant 7315134392

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA-137ALMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Radiology Clinic LLC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093759805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 PAUL BRYANT DR E",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354012094",
            "telephone_number": "205-345-0192",
            "fax_number": "205-247-2194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 PAUL BRYANT DR E",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354012094",
            "telephone_number": "205-345-0192",
            "fax_number": "205-247-2194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATHAM",
        "first_name": "HUGH",
        "middle_name": "RANDALL",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AL",
            "license": "PA-137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "51042288",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tuscaloosa, AL

Sources for this page

Verify at the official NPI Registry.