1902817364 NPI number — MR. MICHAEL K HANKINS CRNA

Table of content: MR. MICHAEL K HANKINS CRNA (NPI 1902817364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902817364 NPI number — MR. MICHAEL K HANKINS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANKINS
Provider First Name:
MICHAEL
Provider Middle Name:
K
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1902817364
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 SOUTHFIELD DR
Provider Second Line Business Mailing Address:
SUITE 1370
Provider Business Mailing Address City Name:
PLAINFIELD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46168-4498
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-837-5571
Provider Business Mailing Address Fax Number:
317-837-5580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46122-1948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-745-4451
Provider Business Practice Location Address Fax Number:
317-718-6740
Provider Enumeration Date:
08/11/2006

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: 367500000X , with the licence number:  28118655A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X , with the licence number: RN193589 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 1064618 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000542738 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 74370610 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 430078077 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000110859 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 0807916 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100359380 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000642061 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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