1639163843 NPI number — CRAIG STEPHEN HAMMES M.D.

Table of content: CRAIG STEPHEN HAMMES M.D. (NPI 1639163843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639163843 NPI number — CRAIG STEPHEN HAMMES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMMES
Provider First Name:
CRAIG
Provider Middle Name:
STEPHEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1639163843
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11995 SINGLETREE LN
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
EDEN PRAIRIE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55344-5347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-595-1242
Provider Business Mailing Address Fax Number:
952-935-2757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
885 1650 LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELTA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81416-8107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-595-1242
Provider Business Practice Location Address Fax Number:
952-935-2757
Provider Enumeration Date:
09/01/2005

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: 2085N0904X , with the licence number:  32568 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 32568 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0204X , with the licence number: 32568 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085U0001X , with the licence number: 32568 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 483724787 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: HAC2708 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 01325687 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 195679 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 841184495001 . This is a "RMHP" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: XPY185580 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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