MEDICARE: DR. JOHN RICHARD HOVIOUS III M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	0000013744	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000013744	OTHER	TN	MEDICAL LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	096148	OTHER	VA	ANTHEM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	44D0672628	OTHER	TN	CLIA NUMBER
6	71056376201	OTHER	TN	JOHN DEERE
7	110289	OTHER	TN	BLUECROSS/BLUESHIELD TENN
8	4531227	OTHER	TN	AETNA

General Provider Information

NPI Number	:	1811994981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN RICHARD HOVIOUS III M.D.

Provider Business Mailing Address
First Line	:	109 MEADOW VIEW ROAD
Second Line	:	SUITE 7
City	:	BRISTOL
State	:	TN
Zip	:	37620-1661
Country	:	US
Telephone Number	:	423-652-1655
Fax Number	:	423-652-7668

Provider Business Practice Location Address
First Line	:	109 MEADOW VIEW ROAD
Second Line	:	SUITE 7
City	:	BRISTOL
State	:	TN
Zip	:	37620-1661
Country	:	US
Telephone Number	:	423-652-1655
Fax Number	:	423-652-7668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	04/06/2023

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