Basic Information
| Provider Information | |||||||||
| NPI: | 1750368197 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANSEN | ||||||||
| FirstName: | HANS | ||||||||
| MiddleName: | CHRISTIAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1224 COMMERCE ST SW | ||||||||
| Address2: | STE A | ||||||||
| City: | CONOVER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286138245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282610467 | ||||||||
| FaxNumber: | 8282670599 | ||||||||
| Practice Location | |||||||||
| Address1: | 1224 COMMERCE ST SW | ||||||||
| Address2: | |||||||||
| City: | CONOVER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286138249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282610467 | ||||||||
| FaxNumber: | 8282670599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 12/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 39278 | NC | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LA0401X | 2014459 | NC | N | Allopathic & Osteopathic Physicians | Anesthesiology | Addiction Medicine | 207LP2900X | 20163 | NC | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP2900X | 39278 | NC | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208VP0000X | 39278 | NC | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2150437M | 01 | NC | MEDICARE PTAN | OTHER | 39083 | 01 | NC | BCBS NC | OTHER | P00667936 | 01 | NC | RR MEDICARE | OTHER | 8939083 | 05 | NC | MEDICAID |