Provider Demographics
NPI:1164621140
Name:HOSEA WILLIAM HAWKINS, DO
Entity Type:Organization
Organization Name:HOSEA WILLIAM HAWKINS, DO
Other - Org Name:MADERA MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRIL
Authorized Official - Middle Name:S
Authorized Official - Last Name:METELKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-673-5181
Mailing Address - Street 1:1050 E ALMOND AVE
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5698
Mailing Address - Country:US
Mailing Address - Phone:559-673-5181
Mailing Address - Fax:559-673-5184
Practice Address - Street 1:1050 E ALMOND AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5698
Practice Address - Country:US
Practice Address - Phone:559-673-5181
Practice Address - Fax:559-673-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
080131374OtherRAILROAD RETIREMENT
1932103603OtherTYPE I NPI
CARHM53813FMedicaid
CAGR0052150Medicaid
CA00AX44210Medicaid
CAGR0052150Medicaid
E71445Medicare UPIN
CA020A44210Medicare Oscar/Certification
1932103603OtherTYPE I NPI