1104852292 NPI number — DR. NATHAN C HAMAKER MD

Table of content: DR. NATHAN C HAMAKER MD (NPI 1104852292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104852292 NPI number — DR. NATHAN C HAMAKER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMAKER
Provider First Name:
NATHAN
Provider Middle Name:
C
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:
1104852292
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4801 S CLIFF AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64055-7015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-478-1230
Provider Business Mailing Address Fax Number:
816-478-4413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1613 S 7 HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUE SPRINGS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64014-3946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-478-1230
Provider Business Practice Location Address Fax Number:
816-478-4413
Provider Enumeration Date:
06/23/2006

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: 207W00000X , with the licence number:  2007010850 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00411373 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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