Provider Demographics
NPI:1568541282
Name:HANSEN MEDICAL GROUP, PC
Entity Type:Organization
Organization Name:HANSEN MEDICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-380-2013
Mailing Address - Street 1:3230 E FLAMINGO RD STE 8
Mailing Address - Street 2:PMB 284
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4330
Mailing Address - Country:US
Mailing Address - Phone:702-380-2013
Mailing Address - Fax:702-987-1385
Practice Address - Street 1:4560 S EASTERN AVE STE 14
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6182
Practice Address - Country:US
Practice Address - Phone:702-380-2013
Practice Address - Fax:702-987-1385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1271261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1649229931Medicare UPIN