Provider Demographics
NPI:1871100503
Name:HAYE, MASON P (PA-C, ATC)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:P
Last Name:HAYE
Suffix:
Gender:M
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 E DAY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3444
Mailing Address - Country:US
Mailing Address - Phone:574-271-5151
Mailing Address - Fax:574-271-5175
Practice Address - Street 1:270 E DAY RD STE 200
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3444
Practice Address - Country:US
Practice Address - Phone:574-271-5151
Practice Address - Fax:574-271-5175
Is Sole Proprietor?:No
Enumeration Date:2020-09-27
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN10003568A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN565800053OtherMEDICARE PTAN
IN261970165OtherMEDICARE PTAN
IN300060319Medicaid