Provider Demographics
NPI:1902583636
Name:HUGHES, TAVONTE JAMAL
Entity Type:Individual
Prefix:
First Name:TAVONTE
Middle Name:JAMAL
Last Name:HUGHES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 RUTLEDGE ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-2244
Mailing Address - Country:US
Mailing Address - Phone:219-689-3817
Mailing Address - Fax:
Practice Address - Street 1:1329 RUTLEDGE ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-2244
Practice Address - Country:US
Practice Address - Phone:219-689-3817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-04
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1670514124343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)