Healthcare Provider Details

I. General information

NPI: 1457010209
Provider Name (Legal Business Name): HNC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 MAGNOLIA AVE.
CLOVIS CA
93611
US

IV. Provider business mailing address

576 N MAGNOLIA AVE
CLOVIS CA
93611-9207
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: 559-242-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN WIEMANN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 937-614-9594