Provider Demographics
NPI:1154316297
Name:HANKEY, JOHN CLARKE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CLARKE
Last Name:HANKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 TUCANA DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2827
Mailing Address - Country:US
Mailing Address - Phone:412-708-3996
Mailing Address - Fax:
Practice Address - Street 1:29101 HOSPITAL RD
Practice Address - Street 2:EMERGENCY MEDICINE MOUNTAIN COMMUNITY HOSPITAL
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352-9706
Practice Address - Country:US
Practice Address - Phone:909-336-3651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022336E207P00000X
CAG44961207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0862606Medicaid
WV1810194000Medicaid
PA0007345900003Medicaid
OH0862606Medicaid
CAFV649XMedicare PIN
PA403538GXFMedicare PIN
PA930115794Medicare PIN