Provider Demographics
NPI:1114071206
Name:HACKETT MEDICAL LTD
Entity Type:Organization
Organization Name:HACKETT MEDICAL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER HACKETT MEDICAL LTD.
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:NOFZIGER
Authorized Official - Last Name:HACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-205-1529
Mailing Address - Street 1:8300 TYLER BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4217
Mailing Address - Country:US
Mailing Address - Phone:440-205-1529
Mailing Address - Fax:440-205-0840
Practice Address - Street 1:8300 TYLER BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4217
Practice Address - Country:US
Practice Address - Phone:440-205-1529
Practice Address - Fax:440-205-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043939207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2178905Medicaid
OH9309561Medicare ID - Type Unspecified