Max Hansen Surgery PLLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

MAX HANSEN SURGERY PLLC

Practice address

381 E 4TH N Ste 100
Rexburg, ID 83440-1684

Phone

(208) 656-8442

Fax

(208) 656-8453

NPI assigned

Mar 15, 2022

Last updated

Mar 15, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dwayne Maxwell Hansen Jr., DONPI 1871013938

Title

Doctor of Osteopath - Surgeon

Phone

(208) 656-8442

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dwayne Maxwell Hansen Jr., DO

  • Surgery Physician
  • Rexburg, ID
  • NPI 1871013938
  Medicare reassignment NPD Authorized official
• Dwayne M Hansen, M.D.

  • Surgery Physician
  • Rexburg, ID
  • NPI 1376581546
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647302400000",
    "number": "1497403760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 185",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834400185",
            "telephone_number": "208-656-8442",
            "fax_number": "208-656-8453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "381 E 4TH N STE 100",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401684",
            "telephone_number": "208-656-8442",
            "fax_number": "208-656-8453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAX HANSEN SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-15",
        "last_updated": "2022-03-15",
        "certification_date": "2022-03-15",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "DWAYNE",
        "authorized_official_middle_name": "MAXWELL",
        "authorized_official_title_or_position": "DOCTOR OF OSTEOPATH - SURGEON",
        "authorized_official_telephone_number": "208-656-8442",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roy H. Marlowe, PH.D.
• Emily Morgan Marriott
• Daniel R Marshall, DO
• Matthew Scott Matson, PT, DPT
• Spencer E. Mauseth, D.D.S.
• Kurt R Mayberry, MD
• James McCoy, MD
• Mia McCune
• Scott J McCurdy, OPTICIAN
• Amy Anne McDougal, PHARM.D

• Surgery Physician in Rexburg, ID
• Providers in Rexburg, ID by specialty
• Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.