Provider Demographics
NPI:1487841169
Name:HAMMERBECK, TOMMY DEAN JR (SA-C/CST)
Entity Type:Individual
Prefix:MR
First Name:TOMMY
Middle Name:DEAN
Last Name:HAMMERBECK
Suffix:JR
Gender:M
Credentials:SA-C/CST
Other - Prefix:
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Mailing Address - Street 1:PO BOX 283
Mailing Address - Street 2:35 CHURCH STREET
Mailing Address - City:LUDLOW
Mailing Address - State:PA
Mailing Address - Zip Code:16333-0283
Mailing Address - Country:US
Mailing Address - Phone:814-945-6350
Mailing Address - Fax:
Practice Address - Street 1:4372 ROUTE 6
Practice Address - Street 2:
Practice Address - City:KANE
Practice Address - State:PA
Practice Address - Zip Code:16735-3060
Practice Address - Country:US
Practice Address - Phone:814-837-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA07-263 SA-C363AS0400X
246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist