Casey Hanna MD Professional Corporation

Key facts

NPI

1003099276

Entity type

Organization (NPI type 2)

Primary specialty

Family Medicine Physician 207Q00000X

License

21947 (OK)

Legal business name

CASEY HANNA MD PROFESSIONAL CORPORATION

Practice address

1202 W Cherokee St Ste E
Wagoner, OK 74467-4629

Phone

(918) 485-5188

Fax

(915) 485-5402

NPI assigned

Dec 11, 2007

Organization subpart

No

Authorized official

Name

Bryan Casey Hanna, MD

Title

Owner

Phone

(918) 485-5188

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 22, 2009.

{
    "created_epoch": "1197331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248220800000",
    "number": "1003099276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 894",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744770894",
            "telephone_number": "918-485-5188",
            "fax_number": "918-485-5402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 W CHEROKEE ST STE E",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744674629",
            "telephone_number": "918-485-5188",
            "fax_number": "915-485-5402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASEY HANNA MD PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-11",
        "last_updated": "2009-07-22",
        "status": "A",
        "authorized_official_last_name": "HANNA",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "CASEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-485-5188",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "21947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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