Provider Demographics
NPI:1821060385
Name:HACK, ROBERT T (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:HACK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84565 DREW LN
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:OR
Mailing Address - Zip Code:97455-9795
Mailing Address - Country:US
Mailing Address - Phone:541-747-8431
Mailing Address - Fax:541-747-6231
Practice Address - Street 1:85463 SVARVERUD RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-9427
Practice Address - Country:US
Practice Address - Phone:541-345-4343
Practice Address - Fax:541-345-4350
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000032949367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR137644Medicare PIN
ORR138105Medicare PIN
ORR138106Medicare PIN
OR043WCGHVCMedicare ID - Type Unspecified