MEDICARE: MICHAEL LEE HANSON PAC

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	363A00000X	Physician Assistant	1622	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033104799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LEE HANSON PAC

Provider Business Mailing Address
First Line	:	2643 PATTERSON RD
Second Line	:	SUITE 503
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-1953
Country	:	US
Telephone Number	:	970-245-2400
Fax Number	:	970-242-9092

Provider Business Practice Location Address
First Line	:	2643 PATTERSON RD
Second Line	:	SUITE 503
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-1953
Country	:	US
Telephone Number	:	970-245-2400
Fax Number	:	970-242-9092

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	09/16/2016

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