Provider Demographics
NPI:1376730119
Name:JOSE GOCHOCO DO PLLC
Entity Type:Organization
Organization Name:JOSE GOCHOCO DO PLLC
Other - Org Name:EXPRESS MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOCHOCO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-718-4375
Mailing Address - Street 1:PO BOX 4450
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86402-4450
Mailing Address - Country:US
Mailing Address - Phone:928-718-4375
Mailing Address - Fax:928-222-0227
Practice Address - Street 1:2002 STOCKTON HILL RD
Practice Address - Street 2:#102
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4698
Practice Address - Country:US
Practice Address - Phone:928-279-3109
Practice Address - Fax:928-222-0227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ118144Medicare PIN