Provider Demographics
NPI:1104260652
Name:HANGGE, CHARLES JUSTIN
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JUSTIN
Last Name:HANGGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 COURTOIS ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-7712
Mailing Address - Country:US
Mailing Address - Phone:314-420-7375
Mailing Address - Fax:
Practice Address - Street 1:2862 CHAMPIONSHIP BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-5269
Practice Address - Country:US
Practice Address - Phone:314-420-7375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOB-60382146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic