Provider Demographics
NPI:1245425321
Name:METTE HANSEN MD PC
Entity Type:Organization
Organization Name:METTE HANSEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:METTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-628-0966
Mailing Address - Street 1:620 S 400 E
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3700
Mailing Address - Country:US
Mailing Address - Phone:435-628-0966
Mailing Address - Fax:435-652-9173
Practice Address - Street 1:1490 E FOREMASTER DR
Practice Address - Street 2:SUITE 150
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4488
Practice Address - Country:US
Practice Address - Phone:435-628-0966
Practice Address - Fax:435-652-9173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT575311-1205208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1063445682Medicaid
UT1063445682Medicaid