MEDICARE: MS. TRICIA HOFFMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0695	SD

General Provider Information

NPI Number	:	1174775928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRICIA HOFFMAN

Provider Business Mailing Address
First Line	:	PO BOX 6020
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57709-6020
Country	:	US
Telephone Number	:	605-342-3280
Fax Number	:	605-721-8438

Provider Business Practice Location Address
First Line	:	717 SAINT FRANCIS STREET
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701
Country	:	US
Telephone Number	:	605-342-2880
Fax Number	:	605-388-4617

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	12/01/2016

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