Provider Demographics
NPI:1821434499
Name:JEFF E. HAGEN MD
Entity Type:Organization
Organization Name:JEFF E. HAGEN MD
Other - Org Name:AUSTIN OBGYN BASTROP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-304-0318
Mailing Address - Street 1:301 HIGHWAY 71 W
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-4105
Mailing Address - Country:US
Mailing Address - Phone:521-304-0318
Mailing Address - Fax:512-308-9649
Practice Address - Street 1:301 HIGHWAY 71 W
Practice Address - Street 2:SUITE 111
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-4105
Practice Address - Country:US
Practice Address - Phone:521-304-0318
Practice Address - Fax:512-308-9649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041869104Medicaid
TX610342Medicare UPIN
TXC16434Medicare UPIN