1972598258 NPI number — DR. WILLIAM B HASS OD

Table of content: DR. WILLIAM B HASS OD (NPI 1972598258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972598258 NPI number — DR. WILLIAM B HASS OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASS
Provider First Name:
WILLIAM
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1972598258
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 68
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESANING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48616-0068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-845-3835
Provider Business Mailing Address Fax Number:
989-845-3982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1180 W BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESANING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48616-1006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-845-3835
Provider Business Practice Location Address Fax Number:
989-845-3982
Provider Enumeration Date:
09/13/2005

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: 152W00000X , with the licence number:  4901002552 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0G36400 . This is a "MEDICARE ID" identifier . This identifiers is of the category "OTHER".




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