Basic Information
| Provider Information | |||||||||
| NPI: | 1528173325 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HACKETT | ||||||||
| FirstName: | RAYMOND | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1325 | ||||||||
| Address2: | |||||||||
| City: | CORBIN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407021325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065268131 | ||||||||
| FaxNumber: | 6065288661 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 BRYAN BLVD | ||||||||
| Address2: | |||||||||
| City: | CORBIN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407012775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065281172 | ||||||||
| FaxNumber: | 6065287169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 12/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 30657 | MN | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 45767 | KY | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 06173HA | 01 | BLUE CROSS | OTHER | 084583300 | 05 | MN | MEDICAID | 1900010 | 01 | MEDICA PRIMARY | OTHER | 961240267002 | 01 | PREFERRED ONE | OTHER | P01427472 | 01 | KY | RR MEDICARE | OTHER | 1912600 | 01 | MEDICA | OTHER | A06082 | 01 | WAUSAU | OTHER | HP13441 | 01 | HEALTHPARTNERS | OTHER | 101379C118 | 01 | UCARE | OTHER | 340004898 | 01 | MN | RAILROAD MEDICARE | OTHER | 34603700 | 05 | WI | MEDICAID | 7100228250 | 05 | KY | MEDICAID |