Healthcare Provider Details

I. General information

NPI: 1437102779
Provider Name (Legal Business Name): MELODY SUE HOOVER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8460 US HIGHWAY 42
FLORENCE KY
41042-9642
US

IV. Provider business mailing address

2300 CHAMBER CENTER DR SUITE 200
LAKESIDE PARK KY
41017-1673
US

V. Phone/Fax

Practice location:
  • Phone: 859-647-2900
  • Fax: 859-647-0140
Mailing address:
  • Phone: 859-344-5555
  • Fax: 859-344-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35056533
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number24625
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: