Provider Demographics
NPI:1114470655
Name:HAMERLY HEALTH CARE PLC
Entity Type:Organization
Organization Name:HAMERLY HEALTH CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:HAMERLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-235-4060
Mailing Address - Street 1:9429 JANE RD N
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-8517
Mailing Address - Country:US
Mailing Address - Phone:651-235-4060
Mailing Address - Fax:
Practice Address - Street 1:9429 JANE RD N
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-8517
Practice Address - Country:US
Practice Address - Phone:651-235-4060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA96488Medicare UPIN