Provider Demographics
NPI:1235110305
Name:HOCK, THOMAS J (PAC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:HOCK
Suffix:
Gender:M
Credentials:PAC
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Mailing Address - Street 1:20 9TH ST SE
Mailing Address - Street 2:CENTRACARE HEALTH SYSTEM - LONG PRAIRIE
Mailing Address - City:LONG PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:56347-1404
Mailing Address - Country:US
Mailing Address - Phone:320-732-2141
Mailing Address - Fax:320-732-6913
Practice Address - Street 1:815 HIGHWAY 71S
Practice Address - Street 2:EAGLE VALLEY CLINIC - A SERVICE OF CENTRACARE HEALTH SY
Practice Address - City:EAGLE BEND
Practice Address - State:MN
Practice Address - Zip Code:55446
Practice Address - Country:US
Practice Address - Phone:218-738-2804
Practice Address - Fax:218-738-5263
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2013-01-07
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Provider Licenses
StateLicense IDTaxonomies
MN9226363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
80D44HOOtherBLUE CROSS BLUE SHIELD
COMPOtherARAZ GROUP AMERICAS PPO
COMPOtherCHAMPUS
COMPOtherONE HEALTH PLAN GREAT WES
0114030OtherMEDICA HEALTH PLANS
MN512014400Medicaid
970006546OtherRR MEDICARE
COMPOtherMMSI
HP22993OtherHEALTH PARTNERS
COMPOtherFIRST HEALTH PLAN
COMPOtherPREFERRED ONE
122064OtherU CARE
MN512014400Medicaid
COMPOtherPREFERRED ONE