1235110305 NPI number — THOMAS J. HOCK PA.C

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235110305 NPI number — THOMAS J. HOCK PA.C

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

HOCK

Provider First Name:

THOMAS

Provider Middle Name:

J.

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

PA.C

Provider Gender Code:

M

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:

1235110305

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/07/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

20 9TH ST SE

Provider Second Line Business Mailing Address:

CENTRACARE HEALTH SYSTEM - LONG PRAIRIE

Provider Business Mailing Address City Name:

LONG PRAIRIE

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

56347-1404

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

320-732-2141

Provider Business Mailing Address Fax Number:

320-732-6913

Provider First Line Business Practice Location Address:

815 HIGHWAY 71S

Provider Second Line Business Practice Location Address:

EAGLE VALLEY CLINIC - A SERVICE OF CENTRACARE HEALTH SY

Provider Business Practice Location Address City Name:

EAGLE BEND

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

55446

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

218-738-2804

Provider Business Practice Location Address Fax Number:

218-738-5263

Provider Enumeration Date:

11/07/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 363AM0700X , with the licence number:  9226 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 80D44HO . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: COMP . This is a "ARAZ GROUP AMERICAS PPO" identifier . This identifiers is of the category "OTHER".
• Identifier: COMP . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
• Identifier: COMP . This is a "ONE HEALTH PLAN GREAT WES" identifier . This identifiers is of the category "OTHER".
• Identifier: 0114030 . This is a "MEDICA HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
• Identifier: 512014400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 970006546 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: COMP . This is a "MMSI" identifier . This identifiers is of the category "OTHER".
• Identifier: HP22993 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
• Identifier: COMP . This is a "FIRST HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: COMP . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
• Identifier: 122064 . This is a "U CARE" identifier . This identifiers is of the category "OTHER".