Individual
MASON P HAYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, ATC
Contact information
Practice address
270 E DAY RD STE 200, MISHAWAKA, IN 46545-3444
(574) 271-5151
(574) 271-5175
Mailing address
270 E DAY RD STE 200, MISHAWAKA, IN 46545-3444
(574) 271-5151
(574) 271-5175
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003568A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
261970165
MEDICARE PTAN
IN
05
—
300060319
—
IN
01
—
565800053
MEDICARE PTAN
IN
Enumeration date
09/27/2020
Last updated
12/06/2022
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