1356325302 NPI number — JESSE D HOFF MD

Table of content: JESSE D HOFF MD (NPI 1356325302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356325302 NPI number — JESSE D HOFF MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOFF
Provider First Name:
JESSE
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356325302
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 WEBER RD
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63640-3326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-756-1721
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 WEBER ROAD
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-756-1299
Provider Business Practice Location Address Fax Number:
573-756-2747
Provider Enumeration Date:
12/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  R7G45 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 01031999A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 202382313 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 226150 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: A11632 . This is a "MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 385481 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 18183 . This is a "HEALTHCARE USA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 115174 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0101495 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".




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