1225026230 NPI number — DR. LANCE M HOOVER MD

Table of content: DR. LANCE M HOOVER MD (NPI 1225026230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225026230 NPI number — DR. LANCE M HOOVER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOOVER
Provider First Name:
LANCE
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225026230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4925 N O'CONNOR RD
Provider Second Line Business Mailing Address:
#105
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-737-4406
Provider Business Mailing Address Fax Number:
214-594-0203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4925 N O'CONNOR
Provider Second Line Business Practice Location Address:
#105
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-565-3502
Provider Business Practice Location Address Fax Number:
214-594-0203
Provider Enumeration Date:
10/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  K3753 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: K3753 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 050049927 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100148860B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 175450200 . This is a "DEPT OF LABOR" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 8BG784 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 198224101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 45490704002 . This is a "BCBS OF OK" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 5809231 . This is a "AETNA" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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