1295837425 NPI number — MARK P HASTINGS, DPM, SC

Table of content: (NPI 1295837425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295837425 NPI number — MARK P HASTINGS, DPM, SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK P HASTINGS, DPM, SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1295837425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N86W16462 JACOBSON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MENOMONEE FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53051-2833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-255-1040
Provider Business Mailing Address Fax Number:
262-255-4090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3431 N 51ST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53216-3228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-255-1040
Provider Business Practice Location Address Fax Number:
262-255-4090
Provider Enumeration Date:
09/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HASTINGS
Authorized Official First Name:
MARK
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
414-873-0772

Provider Taxonomy Codes

  • Taxonomy code: 261QP1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 43214100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41722300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4248430001 . This is a "MEDICARE DME" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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