Provider Demographics
NPI:1518136282
Name:HOFFMANN CLINIC
Entity Type:Organization
Organization Name:HOFFMANN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:HOFFMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-942-2154
Mailing Address - Street 1:199 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-1582
Mailing Address - Country:US
Mailing Address - Phone:715-942-2154
Mailing Address - Fax:715-942-2156
Practice Address - Street 1:199 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-1582
Practice Address - Country:US
Practice Address - Phone:715-942-2154
Practice Address - Fax:715-942-2156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26569261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30628400Medicaid
WI30628400Medicaid