| Eric R. Hansen, D.o., Professional Corporation | |
|
14575 Main St Hesperia CA 92345-3322 | |
| (760) 948-8470 | |
| (760) 947-6219 |
| Full Name | Eric R. Hansen, D.o., Professional Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 14575 Main St, Hesperia, California |
| Authorized Official Name and Position | Eric R Hansen (C.E.O.) |
| Authorized Official Contact | 7609488470 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eric R. Hansen, D.o., Professional Corporation 14575 Main St Hesperia CA 92345-3322 Ph: (760) 948-8470 | Eric R. Hansen, D.o., Professional Corporation 14575 Main St Hesperia CA 92345-3322 Ph: (760) 948-8470 |
| NPI Number | 1912025958 |
|---|---|
| Provider Enumeration Date | 03/27/2007 |
| Last Update Date | 09/24/2015 |
| Medicare PECOS PAC ID | 0042285991 |
|---|---|
| Medicare Enrollment ID | O20040901001538 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912025958 | NPI | - | NPPES |
| DC1926 | Other | CA | RAILROAD MEDICARE |
| 00AX81380 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20A8138 (California) | Primary |
| Provider Name | Eric R Hansen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770562506 PECOS PAC ID: 2860467719 Enrollment ID: I20040902000473 |
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