Provider Demographics
NPI:1396928263
Name:ROBERT L. HOVANCSEK, D.P.M. PS
Entity type:Organization
Organization Name:ROBERT L. HOVANCSEK, D.P.M. PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:HOVANCSEK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:360-533-4344
Mailing Address - Street 1:2218 SIMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-3514
Mailing Address - Country:US
Mailing Address - Phone:360-533-4344
Mailing Address - Fax:360-533-4755
Practice Address - Street 1:2218 SIMPSON AVE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-3514
Practice Address - Country:US
Practice Address - Phone:360-533-4344
Practice Address - Fax:360-533-4755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPO00000531213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA51866OtherLABOR & INDUSTRIES
WAH07445OtherREGENCE BLUE SHIELD
WA1089119Medicaid
WAH07445OtherREGENCE BLUE SHIELD
WA51866OtherLABOR & INDUSTRIES