1194755033 NPI number — ADULT UROLOGY CLINIC PA

Table of content: CHELSEA B HOOVER MS, RD, LD (NPI 1144091133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194755033 NPI number — ADULT UROLOGY CLINIC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADULT UROLOGY CLINIC PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1194755033
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1002 OLD DIXIE HWY.
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33458-5700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-747-5885
Provider Business Mailing Address Fax Number:
561-743-5456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1002 OLD DIXIE HWY.
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
JUPITER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33458-5700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-747-5885
Provider Business Practice Location Address Fax Number:
561-743-5456
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WIITA
Authorized Official First Name:
LUANN
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY TREASURER
Authorized Official Telephone Number:
561-747-5885

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  0014196 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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