Provider Demographics
NPI:1457670713
Name:DARRIN F HANSEN M.D. P.C.
Entity Type:Organization
Organization Name:DARRIN F HANSEN M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:M
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-571-9511
Mailing Address - Street 1:9720 S 1300 E STE W110
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3765
Mailing Address - Country:US
Mailing Address - Phone:801-571-9511
Mailing Address - Fax:801-571-9823
Practice Address - Street 1:9720 S 1300 E STE W110
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3765
Practice Address - Country:US
Practice Address - Phone:801-571-9511
Practice Address - Fax:801-571-9823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT372807-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529330362001Medicaid
UTG25245Medicare UPIN
UT529330362001Medicaid