MEDICARE: MR. JOHN MARK HANNAFORD PA-C

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	363A00000X	Physician Assistant	10000922A	IN

General Provider Information

NPI Number	:	1922121870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN MARK HANNAFORD PA-C

Provider Business Mailing Address
First Line	:	3911 W CLARA LN
Second Line	:	US HEALTH WORKS
City	:	MUNCIE
State	:	IN
Zip	:	47304-5412
Country	:	US
Telephone Number	:	765-288-8800
Fax Number	:	765-751-2278

Provider Business Practice Location Address
First Line	:	3911 W CLARA LN
Second Line	:	US HEALTH WORKS
City	:	MUNCIE
State	:	IN
Zip	:	47304-5412
Country	:	US
Telephone Number	:	765-288-8800
Fax Number	:	765-751-2278

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

Provider Enumeration Date	:	04/07/2007
Last Update Date	:	08/13/2014

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