Healthcare Provider Details

I. General information

NPI: 1003815119
Provider Name (Legal Business Name): MARC A HOFFMEISTER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N MAPLE ST
CHERRYVALE KS
67335-1729
US

IV. Provider business mailing address

4328 CR 4600
INDEPENDENCE KS
67301-7540
US

V. Phone/Fax

Practice location:
  • Phone: 620-336-3244
  • Fax: 620-336-3755
Mailing address:
  • Phone: 620-331-4772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-00335
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: