Provider Demographics
NPI:1114059839
Name:THOMAS S. HASTETTER MD LLC
Entity Type:Organization
Organization Name:THOMAS S. HASTETTER MD LLC
Other - Org Name:EVANSVILLE OBGYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HASTETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-476-6161
Mailing Address - Street 1:7145 E VIRGINIA ST
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-9144
Mailing Address - Country:US
Mailing Address - Phone:812-962-7890
Mailing Address - Fax:812-476-6162
Practice Address - Street 1:7145 E VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715
Practice Address - Country:US
Practice Address - Phone:812-477-7111
Practice Address - Fax:812-477-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1001807AMedicaid