Provider Demographics
NPI:1922248483
Name:JOSEPH HAZAN INC.
Entity type:Organization
Organization Name:JOSEPH HAZAN INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HAZAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-928-1800
Mailing Address - Street 1:4200 NORTH CLOVERLEAF DRIVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:ST. PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376
Mailing Address - Country:US
Mailing Address - Phone:636-928-1800
Mailing Address - Fax:636-928-2226
Practice Address - Street 1:4200 NORTH CLOVERLEAF DRIVE
Practice Address - Street 2:SUITE H
Practice Address - City:ST. PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376
Practice Address - Country:US
Practice Address - Phone:636-928-1800
Practice Address - Fax:636-928-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO35321207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200646727Medicaid
MOA09708Medicare UPIN