1639149818 NPI number — DR. ALAN A HASEGAWA MD

Table of content: DR. ALAN A HASEGAWA MD (NPI 1639149818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639149818 NPI number — DR. ALAN A HASEGAWA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASEGAWA
Provider First Name:
ALAN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
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:
1639149818
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21228
Provider Second Line Business Mailing Address:
DEPARTMENT 31
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74121-1228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-491-5051
Provider Business Mailing Address Fax Number:
918-502-5060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6655 S YALE AVE
Provider Second Line Business Practice Location Address:
LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74136-3326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-491-5051
Provider Business Practice Location Address Fax Number:
918-502-5060
Provider Enumeration Date:
01/23/2006

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: 2084P0800X , with the licence number:  17409 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04501 . This is a "CIGNA BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4306562 . This is a "AETNA BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100216860C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 731308273-006 . This is a "BLUE CROSS B SHIELD OF OK" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com