Provider Demographics
NPI:1992728158
Name:PREVENTATIVE MEDICINE & PRIMARY CARE LLC
Entity type:Organization
Organization Name:PREVENTATIVE MEDICINE & PRIMARY CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:228-497-2652
Mailing Address - Street 1:3300 LADNIER RD
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553
Mailing Address - Country:US
Mailing Address - Phone:228-497-2652
Mailing Address - Fax:228-497-6253
Practice Address - Street 1:3300 LADNIER RD
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553
Practice Address - Country:US
Practice Address - Phone:228-497-2652
Practice Address - Fax:228-497-6253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty