1073521977 NPI number — JOHN R HANSEN MD

Table of content: JOHN R HANSEN MD (NPI 1073521977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073521977 NPI number — JOHN R HANSEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSEN
Provider First Name:
JOHN
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073521977
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12330 METCALF AVE
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66213-1324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-491-1616
Provider Business Mailing Address Fax Number:
913-491-8061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12330 METCALF AVE
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66213-1324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-491-1616
Provider Business Practice Location Address Fax Number:
913-491-8061
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0429103 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100400020A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100400020B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101157 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: D05F416 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7703264 . This is a "AETNA" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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