Healthcare Provider Details

I. General information

NPI: 1952717373
Provider Name (Legal Business Name): NICHOLAS HASTINGS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 N WASHINGTON ST
DU QUOIN IL
62832-1227
US

IV. Provider business mailing address

811 N WASHINGTON ST
DU QUOIN IL
62832-1227
US

V. Phone/Fax

Practice location:
  • Phone: 618-542-2146
  • Fax:
Mailing address:
  • Phone: 618-542-2146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.012449
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR7756
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2024046740
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036168213
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: