1790183960 NPI number — DREW HAMBLIN M.ED, ATC, CES

Table of content: DREW HAMBLIN M.ED, ATC, CES (NPI 1790183960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790183960 NPI number — DREW HAMBLIN M.ED, ATC, CES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMBLIN
Provider First Name:
DREW
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED, ATC, CES
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:
1790183960
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5340 W SAINT PAUL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68524-2104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-472-9870
Provider Business Mailing Address Fax Number:
402-472-2006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE MEMORIAL STADIUM
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:
68588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-472-9870
Provider Business Practice Location Address Fax Number:
402-472-2006
Provider Enumeration Date:
12/19/2014

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: 2255A2300X , with the licence number:  698 , 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)