Basic Information
| Provider Information | |||||||||
| NPI: | 1881724870 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOFF MEDICAL CLINIC, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1702 N KINGSHIGHWAY ST | ||||||||
| Address2: | |||||||||
| City: | CAPE GIRARDEAU | ||||||||
| State: | MO | ||||||||
| PostalCode: | 637012122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733392000 | ||||||||
| FaxNumber: | 5733391876 | ||||||||
| Practice Location | |||||||||
| Address1: | 1702 N KINGSHIGHWAY ST | ||||||||
| Address2: | |||||||||
| City: | CAPE GIRARDEAU | ||||||||
| State: | MO | ||||||||
| PostalCode: | 637012122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733392000 | ||||||||
| FaxNumber: | 5733391876 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 02/03/2012 | ||||||||
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| AuthorizedOfficialLastName: | KEENE | ||||||||
| AuthorizedOfficialFirstName: | GERRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5733392000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R7G45 | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0101495 | 01 | UNITED HEALTH CARE | OTHER | 226150 | 01 | GHP | OTHER | 385481 | 01 | HEALTHLINK | OTHER | 115174 | 01 | BLUE CROSS BLUE SHIELD | OTHER |