Provider Demographics
NPI:1942405535
Name:KATHY HANSEN, MD PA
Entity type:Organization
Organization Name:KATHY HANSEN, MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-332-3713
Mailing Address - Street 1:17030 HIGHWAY 3
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4129
Mailing Address - Country:US
Mailing Address - Phone:281-332-3713
Mailing Address - Fax:
Practice Address - Street 1:17030 HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4129
Practice Address - Country:US
Practice Address - Phone:281-332-3713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0491207Q00000X
TXL6058207Q00000X
TXL3928207Q00000X
TXH7197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80081YOtherBCBS ID
TXG34862Medicare UPIN
TX00U77LMedicare ID - Type UnspecifiedMEDICARE ID
TX80081YOtherBCBS ID
TXI46154Medicare UPIN
TXC32984Medicare UPIN