Provider Demographics
NPI:1801081419
Name:NEAL K HANSEN
Entity type:Organization
Organization Name:NEAL K HANSEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-225-6445
Mailing Address - Street 1:PO BOX 1577
Mailing Address - Street 2:
Mailing Address - City:WARD COVE
Mailing Address - State:AK
Mailing Address - Zip Code:99928-1577
Mailing Address - Country:US
Mailing Address - Phone:907-225-6445
Mailing Address - Fax:907-247-6445
Practice Address - Street 1:9737 MUD BAY RD STE 102
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-9270
Practice Address - Country:US
Practice Address - Phone:907-225-6445
Practice Address - Fax:907-247-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK268848332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMS2688Medicaid
AK4406570001Medicare NSC