Healthcare Provider Details

I. General information

NPI: 1639269335
Provider Name (Legal Business Name): MICHAEL S. HANKS, M.D., P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PRIMROSE ST SUITE 320
SPRINGFIELD MO
65807-5154
US

IV. Provider business mailing address

1000 E PRIMROSE ST SUITE 320
SPRINGFIELD MO
65807-5154
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-3103
  • Fax: 417-269-2315
Mailing address:
  • Phone: 417-269-3103
  • Fax: 417-269-2315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR1G32
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MICHAEL S. HANKS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 417-269-3101