Provider Demographics
NPI:1588638308
Name:HOOVER, PHILLIP ALLEN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:ALLEN
Last Name:HOOVER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 LITTLE JOHN RD
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-8056
Mailing Address - Country:US
Mailing Address - Phone:803-478-2467
Mailing Address - Fax:
Practice Address - Street 1:1531 LITTLE JOHN RD
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-8056
Practice Address - Country:US
Practice Address - Phone:803-478-2467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2017-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN1442367500000X
GARN103413367500000X
VA0024133639367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010275121Medicaid
VAP00354190OtherRAILROAD MEDICARE
SCPENDINGMedicaid
GA717296721AMedicaid
GA511I430084Medicare PIN
SCPENDINGMedicaid
SCPENDINGMedicare UPIN
VA010275121Medicaid