BEVERLY HANSON PA NPI 1003874389

Physician Assistant (Surgical Technologist) in Blackfoot, ID

About BEVERLY HANSON

Beverly Hanson is a provider in Blackfoot, ID. The NPI number assigned to this provider is 1003874389. The practitioner's primary taxonomy code is Physician Assistant (363AS0400X). The provider is registered as an individual and their NPI record was last updated 9 years ago.

NPI1003874389 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider Name BEVERLY HANSON PA
Provider Location Address98 POPLAR ST BLACKFOOT, ID 83221 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address98 POPLAR ST BLACKFOOT, ID 83221 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
GenderFemale
NPI Entity TypeIndividual Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor?No
Is Organization Subpart?N/A Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date05-03-2006 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date09-09-2008 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

BEVERLY HANSON PA
98 POPLAR ST
BLACKFOOT, ID
ZIP 83221
Phone: (208) 782-3993
Fax: (208) 782-3994
Get Directions

Mailing Address

BEVERLY HANSON PA
98 POPLAR ST
BLACKFOOT, ID
ZIP 83221
Phone: (208) 782-3993
Fax: (208) 782-3994

Primary Taxonomy

Taxonomy Code363AS0400X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationPhysician Assistant
TypePhysician Assistants & Advanced Practice Nursing Providers
SpecializationSurgical Technologist
License No.PAG-012
License StateID

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
1667444MEDICARE PIN (08)ID
16674441MEDICARE PIN (08)ID
807338600MEDICAID (05)ID
P55805MEDICARE UPIN (02)ID
000010154328OTHER (01)ID
000010167603OTHER (01)ID
HB405OTHER (01)ID
HPAC6OTHER (01)ID
P00456536MEDICARE PIN (08)ID
PAJ80OTHER (01)ID

Map Location


BEVERLY HANSON PA address is 98 POPLAR ST BLACKFOOT, ID 83221

Other Providers at the same location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1013958099 CHARLES HERBERT LEMON MD
Individual
Emergency Medicine98 POPLAR ST
BLACKFOOT, ID 83221
(208) 785-4100
1053493809DJ MARC CARDINAL, MD PA
Organization
Radiology (Diagnostic Radiology)98 POPLAR ST
BLACKFOOT, ID 83221
(208) 785-3810
1093826513BLACKFOOT ANESTHESIA SERVICES LLC
Organization
Nurse Anesthetist, Certified Registered98 POPLAR ST
BLACKFOOT, ID 83221
(208) 785-4100
1114907532IDAHO PHYSICIANS CLINIC
Organization
Clinic/Center (Rural Health)98 POPLAR ST
BLACKFOOT, ID 83221
(208) 785-3800
1205816626BINGHAM MEMORIAL HOSPITAL
Organization
General Acute Care Hospital (Critical Access)98 POPLAR ST
BLACKFOOT, ID 83221
(208) 785-4100
1245242270DR. WILLIAM DAVIDS PHARMD
Individual
Pharmacist (Pharmacotherapy)98 POPLAR ST
BLACKFOOT, ID 83221
(208) 785-3866
1386685535 DAVID SHELLEY MD
Individual
Radiology (Vascular & Interventional Radiology)98 POPLAR ST
BLACKFOOT, ID 83221
(208) 785-4100
1447269865 BRANDON K PIEPER CRNA
Individual
Nurse Anesthetist, Certified Registered98 POPLAR ST
BLACKFOOT, ID 83221
(208) 785-4100
1578607875 GARY DEAN MYERS PA-C
Individual
Physician Assistant98 POPLAR ST
BLACKFOOT, ID 83221
(208) 785-4100
1609871474DR. WADE H FLOWERS JR. PHARM.D., BCPS, CGP
Individual
Pharmacist (Pharmacotherapy)98 POPLAR ST
BLACKFOOT, ID 83221
(208) 782-3770
1649211319DR. MARK EUGENE JERGENS MD
Individual
Emergency Medicine98 POPLAR ST
BLACKFOOT, ID 83221
(208) 785-4100
1669556213MR. RYAN TODD PORTER PA-C
Individual
Physician Assistant (Surgical Technologist)98 POPLAR ST
BLACKFOOT, ID 83221
(208) 785-4100
1730147000 HEATHER BOURKOVSKI DO
Individual
Obstetrics & Gynecology98 POPLAR ST
BLACKFOOT, ID 83221
(208) 782-3900
1740362797 BRENDA L HATCH CRNA
Individual
Nurse Anesthetist, Certified Registered98 POPLAR ST
BLACKFOOT, ID 83221
(208) 785-4100
1760430367DR. EDUARDO AVILA MD
Individual
Surgery98 POPLAR ST
BLACKFOOT, ID 83221
(208) 782-3993
1871533018 THOMAS J GELWIX MD
Individual
Emergency Medicine98 POPLAR ST
BLACKFOOT, ID 83221
(208) 785-3813
1871547265 CHRISTOPHER L WEHRLI CRNA
Individual
Nurse Anesthetist, Certified Registered98 POPLAR ST
BLACKFOOT, ID 83221
(208) 681-7574
1891877841 STEVE MCCLELLAN CRNA
Individual
Nurse Anesthetist, Certified Registered98 POPLAR ST
BLACKFOOT, ID 83221
(208) 785-4100
1891877858 MATTHEW L MONROE CRNA
Individual
Nurse Anesthetist, Certified Registered98 POPLAR ST
BLACKFOOT, ID 83221
(208) 785-4100
1952483901 LANE T HANSON CRNA
Individual
Nurse Anesthetist, Certified Registered98 POPLAR ST
BLACKFOOT, ID 83221
(208) 785-4100