Provider Demographics
NPI:1962443119
Name:HOOVER, BRADLEY G (CRNA)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:G
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 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:7 INDEPENDENCE PT STE 300
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4569
Practice Address - Country:US
Practice Address - Phone:864-522-3700
Practice Address - Fax:864-522-3705
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN1794367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC576007863OtherUHC
SCP00001216OtherMEDICARE RAILROAD
SC20019210OtherINDIVIDUAL SELECT HEALTH
SC576007863OtherBLUE CHOICE
SCAN1159Medicaid
SC576007863OtherAETNA
SC20031911OtherSELECT HEALTH GOUP
SC576007863OtherCIGNA
SC576007863OtherBCBS
SC576007863OtherUHC