Basic Information
| Provider Information | |||||||||
| NPI: | 1366776957 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOEGH | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | KENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1148 | ||||||||
| Address2: | |||||||||
| City: | POTEAU | ||||||||
| State: | OK | ||||||||
| PostalCode: | 749531148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186478161 | ||||||||
| FaxNumber: | 9186353308 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 WALL ST | ||||||||
| Address2: | |||||||||
| City: | POTEAU | ||||||||
| State: | OK | ||||||||
| PostalCode: | 749534433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186478161 | ||||||||
| FaxNumber: | 9186353308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2009 | ||||||||
| LastUpdateDate: | 09/29/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT1627 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 100678480A | 05 | OK | MEDICAID |