MEDICARE: WILLIAM HAGEE

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1497472740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM HAGEE

Provider Business Mailing Address
First Line	:	5107 W JAY BEND LN UNIT B407
Second Line	:
City	:	HERRIMAN
State	:	UT
Zip	:	84096-1344
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	645 S 1300 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-3206
Country	:	US
Telephone Number	:	385-500-2024
Fax Number	:

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

Provider Enumeration Date	:	10/26/2022
Last Update Date	:	10/26/2022

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Directions to “ WILLIAM HAGEE ” Practice Location

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