Provider Demographics
NPI:1972832368
Name:JOSEPH W HANCE MD PC
Entity Type:Organization
Organization Name:JOSEPH W HANCE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-439-8017
Mailing Address - Street 1:4048 CEDAR BLUFF DR STE 1
Mailing Address - Street 2:PO BOX 430
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8895
Mailing Address - Country:US
Mailing Address - Phone:231-439-8017
Mailing Address - Fax:231-347-6128
Practice Address - Street 1:4048 CEDAR BLUFF DR
Practice Address - Street 2:STE 1
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8895
Practice Address - Country:US
Practice Address - Phone:231-439-8017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039653207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1394080Medicaid
MI1394080Medicaid