Provider Demographics
NPI:1053307231
Name:HOFIUS SURGICAL, INC.
Entity Type:Organization
Organization Name:HOFIUS SURGICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:HOFIUS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-654-3010
Mailing Address - Street 1:217 N JEFFERSON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-2271
Mailing Address - Country:US
Mailing Address - Phone:724-654-3010
Mailing Address - Fax:724-654-3037
Practice Address - Street 1:217 N JEFFERSON ST
Practice Address - Street 2:SUITE B
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-2271
Practice Address - Country:US
Practice Address - Phone:724-654-3010
Practice Address - Fax:724-654-3037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0008334L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019475750002Medicaid
PAF06581Medicare UPIN
PA0019475750002Medicaid