Provider Demographics
NPI:1164699971
Name:CHARLES F HASBROOK MD PC
Entity Type:Organization
Organization Name:CHARLES F HASBROOK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:HASBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-875-5166
Mailing Address - Street 1:1670 W 86TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2182
Mailing Address - Country:US
Mailing Address - Phone:317-875-5166
Mailing Address - Fax:317-876-1670
Practice Address - Street 1:1670 W 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2182
Practice Address - Country:US
Practice Address - Phone:317-875-5166
Practice Address - Fax:317-876-1670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027070261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0478330Medicare PIN
INB28294Medicare UPIN