Active NPI
Tony Christopher Haneca, MED, ATC, CSCS
- Athletic Trainer
- Fargo, ND
National Provider Identifier
1881765261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 295-04
- Practice address
- 1840 15TH Ave S
Fargo, ND 58103-3824 - Phone
- (701) 446-2049
- NPI assigned
- Nov 10, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 295-04 | ND | Primary |
Addresses
Primary practice location
1840 15TH Ave S
Fargo, ND 58103-3824
Mailing address
3022 34TH St S
Moorhead, MN 56560-6937
Phone (218) 359-0723
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 295-04 | ND | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881765261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3022 34TH ST S",
"city": "MOORHEAD",
"state": "MN",
"postal_code": "565606937",
"telephone_number": "218-359-0723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1840 15TH AVE S",
"city": "FARGO",
"state": "ND",
"postal_code": "581033824",
"telephone_number": "701-446-2049"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANECA",
"first_name": "TONY",
"middle_name": "CHRISTOPHER",
"credential": "MED, ATC, CSCS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "ND",
"license": "295-04",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.