Basic Information
| Provider Information | |||||||||
| NPI: | 1477650414 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAGAN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 76 PEACHTREE ROAD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288033505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282743477 | ||||||||
| FaxNumber: | 8282747407 | ||||||||
| Practice Location | |||||||||
| Address1: | 76 PEACHTREE ROAD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288033505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282743477 | ||||||||
| FaxNumber: | 8282747407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 12/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 114654 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 8000315 | 05 | NC | MEDICAID | 260557 | 01 | NC | MEDICARE PTAN | OTHER | 235113E | 01 | NC | MEDICARE PTAN | OTHER | 430043596 | 01 | NC | SWAIN RR MCARE | OTHER | 114654 | 01 | NC | LICENSE NUMBER | OTHER | 8000180 | 05 | NC | MEDICAID | 2625250 | 01 | NC | PROVIDER NO CIGNA | OTHER | 4300035342 | 01 | NC | HARRIS RR MCARE | OTHER |