Provider Demographics
NPI:1780868158
Name:ROBERT P. HANSEN, INC.
Entity Type:Organization
Organization Name:ROBERT P. HANSEN, INC.
Other - Org Name:WILLOW URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-287-9588
Mailing Address - Street 1:PO BOX 2064
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-2064
Mailing Address - Country:US
Mailing Address - Phone:225-363-2193
Mailing Address - Fax:225-363-2276
Practice Address - Street 1:6721 N WILLOW AVE STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5950
Practice Address - Country:US
Practice Address - Phone:225-363-2193
Practice Address - Fax:225-363-2276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53037207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ07635ZOtherMEDICARE GROUP PTAN
CA543403Medicare PIN
CAZZZ07635ZOtherMEDICARE GROUP PTAN