Basic Information
| Provider Information | |||||||||
| NPI: | 1033511464 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCOTT HANSON PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2690 | ||||||||
| Address2: | |||||||||
| City: | PINETOP | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859352690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283676688 | ||||||||
| FaxNumber: | 9283674916 | ||||||||
| Practice Location | |||||||||
| Address1: | 728 E WHITE MOUNTAIN BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | PINETOP | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283676688 | ||||||||
| FaxNumber: | 9283674916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2014 | ||||||||
| LastUpdateDate: | 09/17/2014 | ||||||||
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| AuthorizedOfficialLastName: | PAXMAN | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9283676688 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5806 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.