Provider Demographics
NPI:1922363902
Name:GREGORY HOOVER MD
Entity Type:Organization
Organization Name:GREGORY HOOVER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-850-7494
Mailing Address - Street 1:220 FORT SANDERS WEST BLVD
Mailing Address - Street 2:BUILDING 2 STE 100
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3398
Mailing Address - Country:US
Mailing Address - Phone:865-850-7494
Mailing Address - Fax:888-798-0146
Practice Address - Street 1:220 FORT SANDERS WEST BLVD
Practice Address - Street 2:BUILDING 2 STE 100
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3398
Practice Address - Country:US
Practice Address - Phone:865-850-7494
Practice Address - Fax:888-798-0146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-06
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23756174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4326794OtherBCBS OF TN
TN103I201525Medicare PIN