1619075843 NPI number — MR. JOHN MARTIN HANSEN LP

Table of content: MR. JOHN MARTIN HANSEN LP (NPI 1619075843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619075843 NPI number — MR. JOHN MARTIN HANSEN LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSEN
Provider First Name:
JOHN
Provider Middle Name:
MARTIN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LP
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:
1619075843
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 UNIVERSITY AVE W
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55104-3898
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-434-3325
Provider Business Mailing Address Fax Number:
651-645-2752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2550 UNIVERSITY AVE W
Provider Second Line Business Practice Location Address:
SUITE 229N
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55114-1052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-645-3115
Provider Business Practice Location Address Fax Number:
651-645-2752
Provider Enumeration Date:
09/20/2006

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: 103T00000X , with the licence number:  LP3679 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 795217100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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