1205196946 NPI number — RACHEL HOGAN DO

Table of content: RACHEL HOGAN DO (NPI 1205196946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205196946 NPI number — RACHEL HOGAN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOGAN
Provider First Name:
RACHEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ERICKSON
Provider Other First Name:
RACHEL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1205196946
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17183 INTERSTATE 45 S
Provider Second Line Business Mailing Address:
MEDICAL OFFICE BUILDING 1, SUITE 640
Provider Business Mailing Address City Name:
THE WOODLANDS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-270-3073
Provider Business Mailing Address Fax Number:
936-270-3075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17183 INTERSTATE 45 S
Provider Second Line Business Practice Location Address:
MEDICAL OFFICE BUILDING 1, SUITE 640
Provider Business Practice Location Address City Name:
THE WOODLANDS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-270-3073
Provider Business Practice Location Address Fax Number:
936-270-3075
Provider Enumeration Date:
05/28/2012

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: 207R00000X , with the licence number:  S8188 , 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: 500686065 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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