MEDICARE: H.O.A.N.J., LLC

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	207RH0003X	Hematology & Oncology Physician	35245	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902057748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H.O.A.N.J., LLC

Provider Business Mailing Address
First Line	:	3990 STOCKTON HILL RD
Second Line	:	SUITE F 368
City	:	KINGMAN
State	:	AZ
Zip	:	86409-3024
Country	:	US
Telephone Number	:	928-565-3939
Fax Number	:	877-684-3045

Provider Business Practice Location Address
First Line	:	4263 HWY 68
Second Line	:	SUITE C
City	:	GOLDEN VALLEY
State	:	AZ
Zip	:	86413-8569
Country	:	US
Telephone Number	:	928-565-3939
Fax Number	:	877-684-3045

Authorized Official
Title or Position	:	BILLER
Name	:	MS. TANYA M PECK
Credential	:
Telephone Number	:	928-753-1191

Provider Enumeration Date	:	10/09/2008
Last Update Date	:	10/09/2008

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