Provider Demographics
NPI:1871507178
Name:HOCKENBERRY ANESTHESIA, INC.
Entity Type:Organization
Organization Name:HOCKENBERRY ANESTHESIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOCKENBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:419-232-2866
Mailing Address - Street 1:140 FOX RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2475
Mailing Address - Country:US
Mailing Address - Phone:419-232-2866
Mailing Address - Fax:419-232-2867
Practice Address - Street 1:140 FOX RD
Practice Address - Street 2:SUITE 207
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2475
Practice Address - Country:US
Practice Address - Phone:419-232-2866
Practice Address - Fax:419-232-2867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN226280163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2191686Medicaid
OH000000209221OtherANTHEM BC/BS
OH2191686Medicaid
OH=========00OtherWORKMENS COMP
OH=========004OtherMEDICAL MUTUAL OF OHIO
OH=========004OtherMEDICAL MUTUAL OF OHIO