MEDICARE: NEAL K HANSEN

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	332BX2000X	Oxygen Equipment & Supplies (DME)	268848	AK

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	:	1801081419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEAL K HANSEN

Provider Business Mailing Address
First Line	:	PO BOX 1577
Second Line	:
City	:	WARD COVE
State	:	AK
Zip	:	99928-1577
Country	:	US
Telephone Number	:	907-225-6445
Fax Number	:	907-247-6445

Provider Business Practice Location Address
First Line	:	9737 MUD BAY RD STE 102
Second Line	:
City	:	KETCHIKAN
State	:	AK
Zip	:	99901-9270
Country	:	US
Telephone Number	:	907-225-6445
Fax Number	:	907-247-6445

Authorized Official
Title or Position	:	SOLE OWNER
Name	:	MR. NEAL K HANSEN
Credential	:
Telephone Number	:	907-225-6445

Provider Enumeration Date	:	09/07/2007
Last Update Date	:	10/27/2011

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