1710994330 NPI number — GEORGE H HANSEN MD

Table of content: GEORGE H HANSEN MD (NPI 1710994330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710994330 NPI number — GEORGE H HANSEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSEN
Provider First Name:
GEORGE
Provider Middle Name:
H
Provider Name Prefix Text:
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:
1710994330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 Q ST
Provider Second Line Business Mailing Address:
STE 500
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68503-3610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-421-0896
Provider Business Mailing Address Fax Number:
402-421-0946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 N 26TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68521-4749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-435-5300
Provider Business Practice Location Address Fax Number:
402-435-5511
Provider Enumeration Date:
08/03/2006

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: 207Q00000X , with the licence number:  20384 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 470780857 10 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6627 . This is a "MIDLANDS CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 32031 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 01-00831 . This is a "UHC" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".