Provider Demographics
NPI:1205868031
Name:ANDREW W HOOVER MD PA
Entity Type:Organization
Organization Name:ANDREW W HOOVER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-636-2018
Mailing Address - Street 1:600 S MAIN STREET
Mailing Address - Street 2:#100
Mailing Address - City:RHOME
Mailing Address - State:TX
Mailing Address - Zip Code:76078
Mailing Address - Country:US
Mailing Address - Phone:817-636-2018
Mailing Address - Fax:817-636-2022
Practice Address - Street 1:600 S MAIN ST
Practice Address - Street 2:STE 100
Practice Address - City:RHOME
Practice Address - State:TX
Practice Address - Zip Code:76078
Practice Address - Country:US
Practice Address - Phone:817-636-2018
Practice Address - Fax:817-636-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4214207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0004HWOtherBCBS
80166950OtherRR MCARE
TX00588TMedicare PIN