1730232752 NPI number — HANSON EASTSIDE PHYSICAL THERAPY, INC

Table of content: (NPI 1730232752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730232752 NPI number — HANSON EASTSIDE PHYSICAL THERAPY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HANSON EASTSIDE PHYSICAL THERAPY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1730232752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1914 S SYCAMORE AVE
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57110-4219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-371-4410
Provider Business Mailing Address Fax Number:
605-371-4416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1914 S SYCAMORE AVE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57110-4219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-371-4410
Provider Business Practice Location Address Fax Number:
605-371-4416
Provider Enumeration Date:
01/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HANSON
Authorized Official First Name:
CHAD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER PHYSICAL THERAPIST
Authorized Official Telephone Number:
605-371-4410

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1039 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5834710 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20522 . This is a "SIOUX VALLEY HEALTH PLAN" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 2438329 . This is a "AMERICAS PPO" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4995112 . This is a "WELLMARK BCBS SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 93658HA . This is a "WELLMARK BCBS MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: F246683 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 103978 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 6405469 . This is a "UNITED HEALTH CARE MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 1039 . This is a "DAKOTA CARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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