Provider Demographics
NPI:1902057748
Name:H.O.A.N.J., LLC
Entity Type:Organization
Organization Name:H.O.A.N.J., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-753-1191
Mailing Address - Street 1:3990 STOCKTON HILL RD
Mailing Address - Street 2:SUITE F 368
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3024
Mailing Address - Country:US
Mailing Address - Phone:928-565-3939
Mailing Address - Fax:877-684-3045
Practice Address - Street 1:4263 HWY 68
Practice Address - Street 2:SUITE C
Practice Address - City:GOLDEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86413-8569
Practice Address - Country:US
Practice Address - Phone:928-565-3939
Practice Address - Fax:877-684-3045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35245207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ080714Medicaid
G08323Medicare UPIN