MEDICARE: DARLA J HANSON CMF

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	335E00000X	Prosthetic/Orthotic Supplier	C17792	TX

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
2	530030	OTHER	TX	BC/BS
3	103263100	OTHER	TX	FIRST CARE

General Provider Information

NPI Number	:	1134253578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARLA J HANSON CMF

Provider Business Mailing Address
First Line	:	3302 COUNTY ROAD O
Second Line	:
City	:	ACKERLY
State	:	TX
Zip	:	79713-4038
Country	:	US
Telephone Number	:	432-366-1158
Fax Number	:	432-366-1158

Provider Business Practice Location Address
First Line	:	4101 E 42ND ST
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79762-7239
Country	:	US
Telephone Number	:	432-366-1158
Fax Number	:	432-366-1158

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	06/17/2008

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Directions to “ DARLA J HANSON CMF” Practice Location

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