1629272836 NPI number — MR. MICHAEL JAMES HADDEN LAT ATC

Table of content: MR. MICHAEL JAMES HADDEN LAT ATC (NPI 1629272836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629272836 NPI number — MR. MICHAEL JAMES HADDEN LAT ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HADDEN
Provider First Name:
MICHAEL
Provider Middle Name:
JAMES
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LAT ATC
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:
1629272836
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:
905 SR ST
Provider Second Line Business Mailing Address:
#41
Provider Business Mailing Address City Name:
INDIANOLA
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50125-3515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-962-1307
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SIMPSON COLLEGE
Provider Second Line Business Practice Location Address:
701 NORTH C STREET
Provider Business Practice Location Address City Name:
INDIANOLA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-961-1751
Provider Business Practice Location Address Fax Number:
515-961-1279
Provider Enumeration Date:
06/12/2007

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:  00197 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00197 . This is a "STATE LICENSE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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