Provider Demographics
NPI:1730483348
Name:KENNETH E. HOOGS MD PC
Entity Type:Organization
Organization Name:KENNETH E. HOOGS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:HOOGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-492-4064
Mailing Address - Street 1:100 INTREPID LANE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205
Mailing Address - Country:US
Mailing Address - Phone:315-492-4064
Mailing Address - Fax:315-492-4066
Practice Address - Street 1:100 INTREPID LANE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205
Practice Address - Country:US
Practice Address - Phone:315-492-4064
Practice Address - Fax:315-492-4066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1080211208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00508865Medicaid
NY34969CMedicare PIN
NYC58739Medicare UPIN