Provider Demographics
NPI:1326164526
Name:HANSEN-STULTS SURGICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:HANSEN-STULTS SURGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-586-8192
Mailing Address - Street 1:166 W 1325 N
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-7792
Mailing Address - Country:US
Mailing Address - Phone:435-586-8192
Mailing Address - Fax:435-586-7564
Practice Address - Street 1:166 W 1325 N
Practice Address - Street 2:350
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-7792
Practice Address - Country:US
Practice Address - Phone:435-586-8192
Practice Address - Fax:435-586-7564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3586141205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529966761002Medicaid
UT529966761002Medicaid