1346236882 NPI number — MS. KATY R HOEFT PA-C

Table of content: MS. KATY R HOEFT PA-C (NPI 1346236882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346236882 NPI number — MS. KATY R HOEFT PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOEFT
Provider First Name:
KATY
Provider Middle Name:
R
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NANCE
Provider Other First Name:
KATY
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1346236882
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 N. EL DORADO PLACE
Provider Second Line Business Mailing Address:
F-670
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85715-4637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-324-4774
Provider Business Mailing Address Fax Number:
520-324-2567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6452 E CARONDELET DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85710-2262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-885-5300
Provider Business Practice Location Address Fax Number:
520-885-5309
Provider Enumeration Date:
09/20/2005

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: 363AM0700X , with the licence number:  2863 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 961096 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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