Provider Demographics
NPI:1770685596
Name:HANFORD FAMILY PRACTICE
Entity Type:Organization
Organization Name:HANFORD FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-587-4115
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93232-0906
Mailing Address - Country:US
Mailing Address - Phone:559-587-4115
Mailing Address - Fax:559-587-4189
Practice Address - Street 1:470 GREENFIELD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3513
Practice Address - Country:US
Practice Address - Phone:559-587-4115
Practice Address - Fax:559-587-4189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZZZ26983Z174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26983ZMedicare ID - Type UnspecifiedMEDICARE NUMBER