Provider Demographics
NPI:1336824531
Name:HANSEN MEDICAL LLC
Entity Type:Organization
Organization Name:HANSEN MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:479-337-7521
Mailing Address - Street 1:4803 W HIGHLAND KNOLLS RD STE 150
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-6255
Mailing Address - Country:US
Mailing Address - Phone:479-337-7521
Mailing Address - Fax:
Practice Address - Street 1:4803 W HIGHLAND KNOLLS RD STE 150
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-6255
Practice Address - Country:US
Practice Address - Phone:479-337-7521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care