1609098219 NPI number — MRS. EMILY ANN EVANS-HOEKER M.D.

Table of content: MRS. EMILY ANN EVANS-HOEKER M.D. (NPI 1609098219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609098219 NPI number — MRS. EMILY ANN EVANS-HOEKER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVANS-HOEKER
Provider First Name:
EMILY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EVANS
Provider Other First Name:
EMILY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609098219
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 HIGHLAND AVE SE
Provider Second Line Business Mailing Address:
SUITE 304
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24013-2256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-985-9715
Provider Business Mailing Address Fax Number:
540-985-8487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 HIGHLAND AVE SE
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24013-2256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-985-9715
Provider Business Practice Location Address Fax Number:
540-985-8487
Provider Enumeration Date:
05/03/2007

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: 207VE0102X , with the licence number:  2011-01333 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VE0102X , with the licence number: 0101256219 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: VVD778A . This is a "MEDICARE PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 29364 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com