Healthcare Provider Details

I. General information

NPI: 1992728158
Provider Name (Legal Business Name): PREVENTATIVE MEDICINE & PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 LADNIER RD
GAUTIER MS
39553
US

IV. Provider business mailing address

3300 LADNIER RD
GAUTIER MS
39553
US

V. Phone/Fax

Practice location:
  • Phone: 228-497-2652
  • Fax: 228-497-6253
Mailing address:
  • Phone: 228-497-2652
  • Fax: 228-497-6253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICK D HOOVER
Title or Position: PHYSICIAN OWNER
Credential: DO
Phone: 228-497-2652