Provider Demographics
NPI:1588829212
Name:DR. RICHARD M. HOFACKER, INC.
Entity Type:Organization
Organization Name:DR. RICHARD M. HOFACKER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HOFACKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-836-7475
Mailing Address - Street 1:50 SAND RUN RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-6200
Mailing Address - Country:US
Mailing Address - Phone:330-836-7475
Mailing Address - Fax:330-836-5100
Practice Address - Street 1:50 SAND RUN RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-6200
Practice Address - Country:US
Practice Address - Phone:330-836-7475
Practice Address - Fax:330-836-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002429213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH27068924400OtherMEDICAL MUTUAL
OH000000139318OtherANTHEM BLUE CROSS AND BLUE SHIELD
OH0692675Medicaid
OH27068924400OtherMEDICAL MUTUAL
OH0692675Medicaid
OH=========OtherSUMMACARE
OHT48636Medicare UPIN