1023066164 NPI number — DOUGLAS ERIC HANSHAW MS, CAC III

Table of content: DOUGLAS ERIC HANSHAW MS, CAC III (NPI 1023066164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023066164 NPI number — DOUGLAS ERIC HANSHAW MS, CAC III

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSHAW
Provider First Name:
DOUGLAS
Provider Middle Name:
ERIC
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, CAC III
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:
1023066164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
751 CR 14A
Provider Second Line Business Mailing Address:
PO BOX 1407
Provider Business Mailing Address City Name:
OURAY
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81427-1407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-596-1412
Provider Business Mailing Address Fax Number:
970-325-0200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 W. COLORADO AVE.
Provider Second Line Business Practice Location Address:
SUITE 225
Provider Business Practice Location Address City Name:
TELLURIDE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-596-1412
Provider Business Practice Location Address Fax Number:
970-325-0200
Provider Enumeration Date:
05/04/2006

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: 101YA0400X , with the licence number:  6365 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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