Provider Demographics
NPI:1831188127
Name:HACK, VICKI (PAC)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:HACK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:701-234-2119
Mailing Address - Fax:
Practice Address - Street 1:420 SOUTH 7TH STREET
Practice Address - Street 2:
Practice Address - City:OAKES
Practice Address - State:ND
Practice Address - Zip Code:58474-2024
Practice Address - Country:US
Practice Address - Phone:701-742-3267
Practice Address - Fax:701-742-3201
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0233363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND25995OtherBLUE SHIELD
ND18955OtherBLUE SHIELD
ND970013748OtherRAILROAD MEDICARE
ND71051Medicaid
ND28594OtherBLUE SHIELD
ND28595OtherBLUE SHIELD
ND18954OtherBLUE SHIELD
ND28596OtherBLUE SHIELD
ND18953OtherBLUE SHIELD
NDCF8850OtherRAILROAD MEDICARE
ND18953OtherBLUE SHIELD
ND71051Medicaid
ND28595OtherBLUE SHIELD
P02347Medicare UPIN