Provider Demographics
NPI:1699000562
Name:HOFHEINZ, MARIO R (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:R
Last Name:HOFHEINZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 SANTA FE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6964
Mailing Address - Country:US
Mailing Address - Phone:501-833-3833
Mailing Address - Fax:501-833-8191
Practice Address - Street 1:2215 WILDWOOD AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-5089
Practice Address - Country:US
Practice Address - Phone:501-833-3833
Practice Address - Fax:501-833-8191
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP-T0932363A00000X
ARPA-395363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57297Medicare PIN
AR57297P214Medicare PIN