Provider Demographics
NPI:1841475233
Name:HOOVER FAMILY MEDICINE
Entity type:Organization
Organization Name:HOOVER FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IN-HOUSE COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:HUDSON DE CORONA
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:205-979-3381
Mailing Address - Street 1:1575 MONTGOMERY HWY
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35216-4510
Mailing Address - Country:US
Mailing Address - Phone:205-979-3381
Mailing Address - Fax:205-979-3726
Practice Address - Street 1:1575 MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-4510
Practice Address - Country:US
Practice Address - Phone:205-979-3381
Practice Address - Fax:205-979-3726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8072261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALD608Medicare UPIN