Provider Demographics
NPI:1528310844
Name:NICHOLAS G HANSON MD PC
Entity type:Organization
Organization Name:NICHOLAS G HANSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-637-2300
Mailing Address - Street 1:230 N HOSPITAL DR
Mailing Address - Street 2:STE 4
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-4221
Mailing Address - Country:US
Mailing Address - Phone:435-637-2300
Mailing Address - Fax:435-637-1581
Practice Address - Street 1:230 N HOSPITAL DR
Practice Address - Street 2:STE 4
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4221
Practice Address - Country:US
Practice Address - Phone:435-637-2300
Practice Address - Fax:435-637-1581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10161981OtherOWNERS DOB