1356339790 NPI number — HANSERS ASSOCIATES

Table of content: (NPI 1356339790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356339790 NPI number — HANSERS ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HANSERS ASSOCIATES
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:
1356339790
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1473 RING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALUMET CITY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60409-5459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-862-8156
Provider Business Mailing Address Fax Number:
708-862-8159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1473 RING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALUMET CITY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60409-5459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-862-8156
Provider Business Practice Location Address Fax Number:
708-862-8159
Provider Enumeration Date:
10/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FATOKI
Authorized Official First Name:
ADEYEMI
Authorized Official Middle Name:
OLUDARE
Authorized Official Title or Position:
ATTENDING PHYSICIAN
Authorized Official Telephone Number:
708-862-8156

Provider Taxonomy Codes

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

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

  • Identifier: 1621962 . This is a "BC/BS PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0360847295 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2140333 . This is a "AETNA LIFE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 6147841 . This is a "CIGNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: N278978 . This is a "HARMONY HEALTH PLAN OF IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 541761812001 . This is a "GREATER CHICAGO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 05453 . This is a "BLUE CHOICE PROVIDER NUM." identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 40433 . This is a "ADVOCATE BETHANY PHO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 800250040000 . This is a "UNITED HEALTH CARE OF ILL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 40527 . This is a "ADVOCATE TRINITY PHO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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