Basic Information
| Provider Information | |||||||||
| NPI: | 1881668986 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOSCH | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 846098 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752846098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033246450 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 520 EAST DOUGLAS BLVD | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035931721 | ||||||||
| FaxNumber: | 9035251240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 11/15/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | K5560 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 042296602 | 05 | TX | MEDICAID | 75-2616977-016 | 01 | TX | TRICARE | OTHER | 75-0818167-022 | 01 | TX | TRICARE | OTHER | 8DW075 | 01 | TX | BCBS | OTHER | 75-0818167-048 | 01 | TX | TRICARE | OTHER | 75-2616977-01 | 01 | TX | TRICARE | OTHER | 75-2616977-066 | 01 | TX | TRICARE | OTHER | 75-2616977-118 | 01 | TX | TRICARE | OTHER | 8EZ019 | 01 | TX | BCBS | OTHER | 75-2616977-129 | 01 | TX | TRICARE | OTHER | 75-1976930-005 | 01 | TX | TRICARE | OTHER | 75-2616977-002 | 01 | TX | TRICARE | OTHER | 75-2616977-023 | 01 | TX | TRICARE | OTHER | P01279303 | 01 | TX | RAIL ROAD | OTHER | 75-0818167-015 | 01 | TX | TRICARE | OTHER | 75-2616977-028 | 01 | TX | TRICARE | OTHER | 8EZ063 | 01 | TX | BCBS | OTHER | 042296603 | 05 | TX | MEDICAID | 75-0818167-044 | 01 | TX | TRICARE | OTHER |