1417395864 NPI number — OLIVER M HASEK LLC

Table of content: (NPI 1417395864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417395864 NPI number — OLIVER M HASEK LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLIVER M HASEK LLC
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:
1417395864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 DOCTORS DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PANAMA CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-234-7961
Provider Business Mailing Address Fax Number:
850-235-8948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 DOCTORS DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PANAMA CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-234-7961
Provider Business Practice Location Address Fax Number:
850-235-8948
Provider Enumeration Date:
06/07/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HASEK
Authorized Official First Name:
OLIVER
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
850-235-8948

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 370002000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 141863 . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".