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1215913520

NPI Code Detail

MEDICARE: VICKI LOU HACKMAN MD

MEDICARE: VICKI LOU HACKMAN 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	207Q00000X	Family Medicine Physician	24411	KY

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	:	1215913520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI LOU HACKMAN MD

Provider Business Mailing Address
First Line	:	1010 MAIN ST S
Second Line	:
City	:	MC KEE
State	:	KY
Zip	:	40447-7089
Country	:	US
Telephone Number	:	606-287-7104
Fax Number	:	606-287-4409

Provider Business Practice Location Address
First Line	:	305 ESTILL ST
Second Line	:
City	:	BEREA
State	:	KY
Zip	:	40403-1742
Country	:	US
Telephone Number	:	859-985-1415
Fax Number	:	859-986-6752

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	02/14/2014

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Directions to “ VICKI LOU HACKMAN MD” Practice Location

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