1699980375 NPI number — MRS. LYDIA STARNS HOOGE MS, LDN, RD

Table of content: MRS. LYDIA STARNS HOOGE MS, LDN, RD (NPI 1699980375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699980375 NPI number — MRS. LYDIA STARNS HOOGE MS, LDN, RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOOGE
Provider First Name:
LYDIA
Provider Middle Name:
STARNS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LDN, RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STARNS
Provider Other First Name:
LYDIA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699980375
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12670 SIMMS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENHAM SPRINGS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70706-0462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-387-7678
Provider Business Mailing Address Fax Number:
225-387-7670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12670 SIMMS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENHAM SPRINGS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70706-0462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-387-7678
Provider Business Practice Location Address Fax Number:
225-387-7670
Provider Enumeration Date:
05/14/2007

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: 133V00000X , with the licence number:  1878 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 930875 . This is a "CDR ID #" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1878 . This is a "LDN #" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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