Provider Demographics
NPI:1104808187
Name:HOFFMAN, BEN G (PAC)
Entity type:Individual
Prefix:MR
First Name:BEN
Middle Name:G
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 CENTRAL AVE
Mailing Address - Street 2:A
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-8624
Mailing Address - Country:US
Mailing Address - Phone:406-252-8346
Mailing Address - Fax:
Practice Address - Street 1:2820 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-8624
Practice Address - Country:US
Practice Address - Phone:406-252-8346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT337363AM0700X
WY311363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000094953OtherBLUE CROSS BILLINGS MT
WY312270OtherBLUE CROSS CODY WY
MT4308759OtherMDCD PIN
MT4301357Medicaid
MT810511516011OtherEBMS
MT000097533OtherBCBS PIN
MT000094963OtherBLUE CROSS BUTTE MT
WY312239OtherBLUE CROSS SHERIDAN WY
MT810511516011OtherEBMS
MT000083280Medicare ID - Type Unspecified
MT000094953OtherBLUE CROSS BILLINGS MT
MT000094963OtherBLUE CROSS BUTTE MT
WY312239OtherBLUE CROSS SHERIDAN WY
WYW9762Medicare ID - Type Unspecified
MT4301357Medicaid
MTP00356151Medicare PIN
WY9762Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WY312270OtherBLUE CROSS CODY WY