Provider Demographics
NPI:1063870632
Name:HOVAH HEALTHCARE P.A
Entity type:Organization
Organization Name:HOVAH HEALTHCARE P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OPEYEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:FALEBITA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-247-7807
Mailing Address - Street 1:PO BOX 1597
Mailing Address - Street 2:
Mailing Address - City:CARRIZO SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78834-7597
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:404 S 8TH ST
Practice Address - Street 2:
Practice Address - City:CARRIZO SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78834-3818
Practice Address - Country:US
Practice Address - Phone:830-876-9060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD244699ZBDGMedicaid
TX470346YKUQMedicaid