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1528173325

NPI Code Detail

MEDICARE: DR. RAYMOND ALLEN HACKETT M.D.

MEDICARE: DR. RAYMOND ALLEN HACKETT M.D.

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	208800000X	Urology Physician	30657	MN
2	208800000X	Urology Physician	45767	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P01427472	OTHER	KY	RR MEDICARE
10	340004898	OTHER	MN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06173HA	OTHER		BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1900010	OTHER		MEDICA PRIMARY
4	961240267002	OTHER		PREFERRED ONE
6	1912600	OTHER		MEDICA
7	A06082	OTHER		WAUSAU
8	HP13441	OTHER		HEALTHPARTNERS
9	101379C118	OTHER		UCARE
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528173325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND ALLEN HACKETT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1325
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40702-1325
Country	:	US
Telephone Number	:	606-526-8131
Fax Number	:	606-528-8661

Provider Business Practice Location Address
First Line	:	140 BRYAN BLVD
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40701-2775
Country	:	US
Telephone Number	:	606-528-1172
Fax Number	:	606-528-7169

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	12/03/2020

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Directions to “ DR. RAYMOND ALLEN HACKETT M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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