=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841220746
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IAN HAYCOCKS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2006
-----------------------------------------------------
Last Update Date | 09/10/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 HOSPITAL DR
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40391-9591
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-230-8200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 75 REMITTANCE DR DEPT 8310
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60675-8310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-444-1919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 10797
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------