1194700070 NPI number — R SCOTT HOFFMAN MD

Table of content: R SCOTT HOFFMAN MD (NPI 1194700070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194700070 NPI number — R SCOTT HOFFMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOFFMAN
Provider First Name:
R
Provider Middle Name:
SCOTT
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:
1194700070
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 206068
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40250-6068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-896-2064
Provider Business Mailing Address Fax Number:
502-897-0489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4004 DUPONT CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-897-1604
Provider Business Practice Location Address Fax Number:
502-897-0489
Provider Enumeration Date:
12/13/2005

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: 207W00000X , with the licence number:  30458 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CB0333 . This is a "GROUP RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64304587 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000068291 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 180041690 . This is a "MEDICARE RR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0351 . This is a "GROUP MEDICARE" identifier . This identifiers is of the category "OTHER".




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