Provider Demographics
NPI:1528004777
Name:HANSON, THOMAS S (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:S
Last Name:HANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:938 MCPHERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-2256
Mailing Address - Country:US
Mailing Address - Phone:618-462-4281
Mailing Address - Fax:
Practice Address - Street 1:1 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6755
Practice Address - Country:US
Practice Address - Phone:618-463-7311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-090592207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08232204OtherBLUE CROSS BLUE SHIELD
IL06032182OtherBLUE CROSS BLUE SHIELD
IL08232205OtherBLUE CROSS BLUE SHIELD
IL036090592Medicaid
IL0008232117OtherBLUE CROSS BLUE SHIELD
IL06032182OtherBLUE CROSS BLUE SHIELD
IL08232204OtherBLUE CROSS BLUE SHIELD
G07558Medicare UPIN
ILK28770Medicare PIN