Provider Demographics
NPI:1851306583
Name:HANSEN MEDICAL PC
Entity Type:Organization
Organization Name:HANSEN MEDICAL PC
Other - Org Name:HANSEN MEDICAL PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REIMERS
Authorized Official - Suffix:
Authorized Official - Credentials:CMOM
Authorized Official - Phone:308-381-8546
Mailing Address - Street 1:3016 W FAIDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803
Mailing Address - Country:US
Mailing Address - Phone:308-381-8546
Mailing Address - Fax:308-381-8550
Practice Address - Street 1:3016 W FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803
Practice Address - Country:US
Practice Address - Phone:308-381-8546
Practice Address - Fax:308-381-8550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE080104974OtherRAILROAD MEDICARE
272911OtherIND
275317OtherIND
MA267431OtherIND
NE10025386100Medicaid
35930OtherBCBS
38552OtherBCBS
00998OtherBCBS
NE080183038OtherRAILROAD MEDICARE
NE10025353400Medicaid
NE970015612OtherRAILROAD MEDICARE
NE=========12Medicaid
NE098013Medicare ID - Type UnspecifiedGROUP
NE=========12Medicaid
00998OtherBCBS
NE970015612OtherRAILROAD MEDICARE
NE0764060001Medicare NSC
NE080183038OtherRAILROAD MEDICARE
NE10025353400Medicaid
NE1477549624Medicare NSC