Basic Information
| Provider Information | |||||||||
| NPI: | 1902801525 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAHN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1228 E RUSHOLME ST | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528032467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5634213122 | ||||||||
| FaxNumber: | 5634213129 | ||||||||
| Practice Location | |||||||||
| Address1: | 1228 E RUSHOLME ST | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528032467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5634213122 | ||||||||
| FaxNumber: | 5634213129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 06/15/2009 | ||||||||
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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 | 207R00000X | 23423 | IA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 15409 | 01 | IA | IOWA MIDLANDS CHOICE | OTHER | IL 1240003 | 01 | IL | ILLINOIS MEDICARE PROVIDER NUMBER | OTHER | P00287447 | 01 | IA | MEDICARE RAILROAD | OTHER | 8201954 | 05 | IA | MEDICAID | 39981 | 01 | IA | WELMARK BCBS | OTHER | 9201954 | 05 | IA | MEDICAID |