MEDICARE: MICHAEL D HACKETT CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	08204	OH
2	367500000X	Certified Registered Nurse Anesthetist	RN356726L	PA
3	367500000X	Certified Registered Nurse Anesthetist	3291412	FL
4	367500000X	Certified Registered Nurse Anesthetist	3004468	KY
5	163W00000X	Registered Nurse	1105174	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	9487921	OTHER		PHCS
4	000000542747	OTHER		ANTHEM
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	70965	OTHER	PA	COUNCIL OF RECERT OF NA #

General Provider Information

NPI Number	:	1184688749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL D HACKETT CRNA

Provider Business Mailing Address
First Line	:	2288 GUNBARREL RD STE 111 PMB 237
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-2670
Country	:	US
Telephone Number	:	412-337-0283
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 ROSE ST
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-7001
Country	:	US
Telephone Number	:	859-323-5956
Fax Number	:	859-323-1080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	04/29/2024

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