=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194741249
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GEOFFREY W HOOVER MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2006
-----------------------------------------------------
Last Update Date | 08/01/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 122 N BRYANT AVE STE 1
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73034-6349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-216-8960
-----------------------------------------------------
Fax | 405-216-8965
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 122 N BRYANT AVE STE 1
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73034-6349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-216-8960
-----------------------------------------------------
Fax | 405-216-8965
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GEOFFREY HOOVER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 405-216-8960
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 21239
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------