Organization
DARLA JO HANSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARLA JO HANSON CMF (OWNER)
(432) 366-1158
Entity
Organization
Contact information
Practice address
4101 E 42ND ST, MUSIC CITY MALL #95, ODESSA, TX 79762-7239
(432) 366-1158
(432) 366-1158
Mailing address
3302 COUNTY ROAD O, ACKERLY, TX 79713-4038
(432) 366-1158
(432) 366-1158
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0107997-01
—
TX
01
—
103263100
FIRST CARE
TX
01
—
530030
BC/BS
TX
Enumeration date
08/18/2006
Last updated
06/13/2008
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