Provider Demographics
NPI:1386843308
Name:DAVID H. HAASE
Entity Type:Organization
Organization Name:DAVID H. HAASE
Other - Org Name:MAXWELL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:WELKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-648-9595
Mailing Address - Street 1:556B FIRE STATION RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4016
Mailing Address - Country:US
Mailing Address - Phone:931-648-9595
Mailing Address - Fax:931-648-9567
Practice Address - Street 1:556B FIRE STATION RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4016
Practice Address - Country:US
Practice Address - Phone:931-648-9595
Practice Address - Fax:931-648-9567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty