1992915292 NPI number — TODD HOFFE

Table of content: TODD HOFFE (NPI 1992915292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992915292 NPI number — TODD HOFFE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOFFE
Provider First Name:
TODD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1992915292
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27962 HOFFE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAKOTA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55925-4179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319 MAIN ST
Provider Second Line Business Practice Location Address:
STE. 302
Provider Business Practice Location Address City Name:
LA CROSSE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54601-0705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-796-1168
Provider Business Practice Location Address Fax Number:
608-796-1944
Provider Enumeration Date:
05/23/2007

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: 101YA0400X , with the licence number:  11306-132 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: 300429 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 39336500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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