Provider Demographics
NPI:1558614818
Name:HOFFMAN SNYDER TLC, LLC
Entity Type:Organization
Organization Name:HOFFMAN SNYDER TLC, LLC
Other - Org Name:HOFFMAN SNYDER TLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-548-9123
Mailing Address - Street 1:229 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOVELL
Mailing Address - State:WY
Mailing Address - Zip Code:82431-2101
Mailing Address - Country:US
Mailing Address - Phone:307-548-9123
Mailing Address - Fax:307-548-9124
Practice Address - Street 1:229 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LOVELL
Practice Address - State:WY
Practice Address - Zip Code:82431-2101
Practice Address - Country:US
Practice Address - Phone:307-548-9123
Practice Address - Fax:307-548-9124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4296A207Q00000X, 208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY134-270-300Medicaid
WYDT6862OtherRAILROAD
WY134-270-300Medicaid