Provider Demographics
NPI:1093869612
Name:WALTER HANCOCK DPM PC
Entity Type:Organization
Organization Name:WALTER HANCOCK DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:812-477-1821
Mailing Address - Street 1:2042 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-1561
Mailing Address - Country:US
Mailing Address - Phone:812-477-1821
Mailing Address - Fax:812-475-0327
Practice Address - Street 1:2042 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-1561
Practice Address - Country:US
Practice Address - Phone:812-477-1821
Practice Address - Fax:812-475-0327
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALTER HANCOCK DPM PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-22
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000330213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000042449OtherANTHEM BLUE SHEILD
IN100110420 A & BMedicaid
IN000000108408OtherANTHEM BLUE SHEILD
IN480068075 AOtherPALMETTO MEDICARE
IN0243760002OtherMEDICARE DME
IN0243760002OtherMEDICARE DME
IN100110420 A & BMedicaid
IN638370Medicare ID - Type Unspecified