1134253578 NPI number — DARLA J HANSON CMF

Table of content: DARLA J HANSON CMF (NPI 1134253578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134253578 NPI number — DARLA J HANSON CMF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSON
Provider First Name:
DARLA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CMF
Provider Gender Code:
F

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:
1134253578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3302 COUNTY ROAD O
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ACKERLY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79713-4038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-366-1158
Provider Business Mailing Address Fax Number:
432-366-1158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4101 E 42ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ODESSA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79762-7239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-366-1158
Provider Business Practice Location Address Fax Number:
432-366-1158
Provider Enumeration Date:
03/16/2007

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: 335E00000X , with the licence number:  C17792 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0107997-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 530030 . This is a "BC/BS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 103263100 . This is a "FIRST CARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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