MEDICARE: CRAIG K. HANSEN

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1447449079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAIG K. HANSEN

Provider Business Mailing Address
First Line	:	2620 JACKSON BLVD
Second Line	:	SUITE C
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3478
Country	:	US
Telephone Number	:	605-341-1208
Fax Number	:	605-341-3552

Provider Business Practice Location Address
First Line	:	2620 JACKSON BLVD
Second Line	:	SUITE C
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3478
Country	:	US
Telephone Number	:	605-341-1208
Fax Number	:	605-341-3552

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CRAIG K HANSEN
Credential	:	M.D.
Telephone Number	:	605-348-1208

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	01/07/2008

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