Provider Demographics
NPI:1356379945
Name:HOF, MELODY (PA-C)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:HOF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S SURREY LN
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-2110
Mailing Address - Country:US
Mailing Address - Phone:618-534-2611
Mailing Address - Fax:
Practice Address - Street 1:1325 CEDAR CT
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5337
Practice Address - Country:US
Practice Address - Phone:618-549-2911
Practice Address - Fax:618-549-2912
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2025-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085000897363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371359450OtherFEDERAL EMPLOYER ID NUMBE
ILCB3700OtherRAILROAD MEDICARE GROUP #
ILK16715OtherUMWA PROVIDER NUMBER
IL970015211OtherRAILROAD PROVIDER NUMBER
ILL84851OtherUMWA PROVIDER NUMBER
ILK16715OtherUMWA PROVIDER NUMBER
ILCB3700OtherRAILROAD MEDICARE GROUP #
IL659080Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER