Basic Information
| Provider Information | |||||||||
| NPI: | 1487841169 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAMMERBECK | ||||||||
| FirstName: | TOMMY | ||||||||
| MiddleName: | DEAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | SA-C/CST | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 283 | ||||||||
| Address2: | 35 CHURCH STREET | ||||||||
| City: | LUDLOW | ||||||||
| State: | PA | ||||||||
| PostalCode: | 163330283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149456350 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4372 ROUTE 6 | ||||||||
| Address2: | |||||||||
| City: | KANE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 167353060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148378585 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2007 | ||||||||
| LastUpdateDate: | 10/18/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 07-263 SA-C | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 246ZS0410X | N |
No ID Information.