Provider Demographics
NPI: | 1477529873 |
---|---|
Name: | HOFFMAN, TIMOTHY RICK (CRNA) |
Entity Type: | Individual |
Prefix: | MR |
First Name: | TIMOTHY |
Middle Name: | RICK |
Last Name: | HOFFMAN |
Suffix: | |
Gender: | M |
Credentials: | CRNA |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 3180 KETTERING BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | DAYTON |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45439-1924 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 937-293-0247 |
Mailing Address - Fax: | 937-293-0960 |
Practice Address - Street 1: | 1141 N MONROE DR |
Practice Address - Street 2: | |
Practice Address - City: | XENIA |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45385 |
Practice Address - Country: | US |
Practice Address - Phone: | 937-372-8011 |
Practice Address - Fax: | 937-376-6983 |
Is Sole Proprietor?: | Not Answered |
Enumeration Date: | 2006-02-24 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | RN144163 | 367500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | P00265259 | Other | RAILROAD MEDICARE |
OH | 0000000381922 | Other | ANTHEM |
OH | 0807014 | Medicaid | |
OH | H08209346 | Medicare ID - Type Unspecified |