MEDICARE: DARLA JO HANSON

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	335E00000X	Prosthetic/Orthotic Supplier

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	103263100	OTHER	TX	FIRST CARE
3	530030	OTHER	TX	BC/BS

General Provider Information

NPI Number	:	1912011602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DARLA JO HANSON

Provider Business Mailing Address
First Line	:	3302 COUNTY ROAD O
Second Line	:
City	:	ACKERLY
State	:	TX
Zip	:	79713-4038
Country	:	US
Telephone Number	:	432-366-1158
Fax Number	:	432-366-1158

Provider Business Practice Location Address
First Line	:	4101 E 42ND ST
Second Line	:	MUSIC CITY MALL #95
City	:	ODESSA
State	:	TX
Zip	:	79762-7239
Country	:	US
Telephone Number	:	432-366-1158
Fax Number	:	432-366-1158

Authorized Official
Title or Position	:	OWNER
Name	:	DARLA JO HANSON
Credential	:	CMF
Telephone Number	:	432-366-1158

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	06/13/2008

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Directions to “DARLA JO HANSON ” Practice Location

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