MEDICARE: JACK S. HOGAN JR.

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	2278G1100X	General Care Certified Respiratory Therapist	4417	SC

General Provider Information

NPI Number	:	1306472535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK S. HOGAN JR.

Provider Business Mailing Address
First Line	:	773 MAIN ST
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3029
Country	:	US
Telephone Number	:	843-269-6737
Fax Number	:	843-281-0126

Provider Business Practice Location Address
First Line	:	773 MAIN ST
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3029
Country	:	US
Telephone Number	:	843-269-6737
Fax Number	:	843-281-0126

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

Provider Enumeration Date	:	03/19/2020
Last Update Date	:	03/19/2020

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