Provider Demographics
NPI:1467510966
Name:RICHARD A HASTINGS MD
Entity Type:Organization
Organization Name:RICHARD A HASTINGS MD
Other - Org Name:BRISTOL STREET FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HASTINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-262-2817
Mailing Address - Street 1:609 W BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-2900
Mailing Address - Country:US
Mailing Address - Phone:574-262-2817
Mailing Address - Fax:574-262-2941
Practice Address - Street 1:609 W BRISTOL ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2900
Practice Address - Country:US
Practice Address - Phone:574-262-2817
Practice Address - Fax:574-262-2941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027071A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100112380AMedicaid
IN100112380AMedicaid
B28623Medicare UPIN