Provider Demographics
NPI:1346282738
Name:HANNAH MEDICAL INSTITUTE LLC
Entity Type:Organization
Organization Name:HANNAH MEDICAL INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOCHUKWI
Authorized Official - Middle Name:SAM
Authorized Official - Last Name:NWAFOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-821-9339
Mailing Address - Street 1:PO BOX 2510
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85214-2510
Mailing Address - Country:US
Mailing Address - Phone:480-821-9339
Mailing Address - Fax:480-821-9555
Practice Address - Street 1:3303 S LINDSAY RD
Practice Address - Street 2:STE 123
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297
Practice Address - Country:US
Practice Address - Phone:480-821-9339
Practice Address - Fax:480-821-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29620174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ635617Medicaid
AZZ111974Medicare PIN
AZ635617Medicaid
AZZ111973Medicare PIN