MEDICARE: CLYDE ARTHUR HANSON DO

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	207P00000X	Emergency Medicine Physician	OP60768791	WA
2	207P00000X	Emergency Medicine Physician	O-231	ID

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	000010028719	OTHER	ID	REGENCE BS IDAHO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	141315	OTHER	WA	WA LABOR & INDUSTRIES
5	601415900	OTHER		DEEIOC
6	S3168	OTHER	ID	BC OF ID

General Provider Information

NPI Number	:	1760540801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLYDE ARTHUR HANSON DO

Provider Business Mailing Address
First Line	:	1593 E POLSTON AVE
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-5326
Country	:	US
Telephone Number	:	208-262-2498
Fax Number	:	208-262-7461

Provider Business Practice Location Address
First Line	:	622 W COLLEGE AVE STE 2
Second Line	:
City	:	ST MARIES
State	:	ID
Zip	:	83861-1822
Country	:	US
Telephone Number	:	208-568-7800
Fax Number	:	877-902-7131

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	02/19/2026

Similar Medicare Providers

1245291772 — DR. RALPH MARC SUTHERLIN D.O.
Practice Location Address:

622 W COLLEGE AVE STE 2
ST MARIES, ID
83861-1822

Practice Phone: 208-568-7800
Practice Fax: 877-902-7131

1992842561 — ANSWERS AND ALTERNATIVES
Practice Location Address:

622 W COLLEGE AVE
ST MARIES, ID
83861-1822

Practice Phone: 208-245-4363
Practice Fax: 208-245-4349

1578602793 — FAMILY AND CHILDREN'S REHABILITATIVE SERVICES
Practice Location Address:

622 W COLLEGE AVE
ST MARIES, ID
83861-1822

Practice Phone: 208-245-4363
Practice Fax: 208-245-4349

1306000575 — KATHLEEN SHEPHERD
Practice Location Address:

622 W COLLEGE AVE STE 2
SAINT MARIES, ID
83861-1822

Practice Phone: 205-245-4363
Practice Fax: 208-245-4349

1750672093 — ALTERNATIVE COMMUNITY ENRICHMENT SERVICES, INC
Practice Location Address:

622 W COLLEGE AVE STE 2
ST MARIES, ID
83861-1822

Practice Phone: 208-245-4363
Practice Fax: 208-245-4349

1790076362 — ALTERNATIVE COMMUNITY ENRICHMENT SERVICES, INC
Practice Location Address:

622 W COLLEGE AVE STE 2
ST MARIES, ID
83861-1822

Practice Phone: 208-245-4363
Practice Fax: 208-245-4349

Directions to “ CLYDE ARTHUR HANSON DO” 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.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.