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1164484994

NPI Code Detail

MEDICARE: KENNETH A HACKER MD

MEDICARE: KENNETH A HACKER MD

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	208600000X	Surgery Physician	R5N50	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	020029159	OTHER		RAILROAD MEDICARE
18	M6725	OTHER		MEDICARE ARKANSAS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	29293	OTHER		BLUE CHOICE
2	4337092	OTHER		AETNA
3	088443	OTHER		GREAT WEST
4	430910980007	OTHER		PRUDENTIAL
5	017069	OTHER		EXCLUSIVE CHOICE
7	1053235	OTHER		CARE PARTNER
8	1328V2907	OTHER		GHP
9	1700152	OTHER		UNITED HEALTHCARE
10	986C2	OTHER	MO	BLUE CROSS BLUE SHIELD
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	G1257A	OTHER		PRINCIPAL
13	209034	OTHER		HEALTHLINK
14	11615	OTHER		ESSENCE
15	BLC27144001	OTHER		BLUE CHOICE
16	SP14388	OTHER		CIGNA
17	000487747642	OTHER		MERCY

General Provider Information

NPI Number	:	1164484994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH A HACKER MD

Provider Business Mailing Address
First Line	:	70 JUNGERMANN CIR STE 405
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1637
Country	:	US
Telephone Number	:	636-916-7100
Fax Number	:	636-916-7110

Provider Business Practice Location Address
First Line	:	70 JUNGERMANN CIR STE 405
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1637
Country	:	US
Telephone Number	:	636-916-7100
Fax Number	:	636-916-7110

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	06/23/2026

Similar Medicare Providers

1528020328 — JENNIFER L ETLING MD
Practice Location Address:

70 JUNGERMANN CIR STE 405
SAINT PETERS, MO
63376-1637

Practice Phone: 636-916-7100
Practice Fax: 636-916-7110

1205878279 — JERAD P MILLER MD
Practice Location Address:

70 JUNGERMANN CIR STE 405
SAINT PETERS, MO
63376-1637

Practice Phone: 636-916-7100
Practice Fax: 636-916-7110

1689169559 — DR. KURT ANDREW PIENING JR. MD
Practice Location Address:

70 JUNGERMANN CIR STE 405
SAINT PETERS, MO
63376-1637

Practice Phone: 636-916-7100
Practice Fax: 636-916-7110

1174585160 — LAUREL A YEAGER MD
Practice Location Address:

70 JUNGERMANN CIR STE 405
SAINT PETERS, MO
63376-1637

Practice Phone: 636-916-7100
Practice Fax: 636-916-7110

1811611494 — MELISSA M FRANKE FNP
Practice Location Address:

70 JUNGERMANN CIR STE 405
SAINT PETERS, MO
63376-1637

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1366439283 — DR. GARY G SINGER M.D.
Practice Location Address:

70 JUNGERMANN CIR STE 302
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Practice Phone: 636-720-0310
Practice Fax: 636-720-0311

Directions to “ KENNETH A HACKER MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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