Basic Information
Provider Information
NPI: 1629274576
EntityType: 2
ReplacementNPI:  
OrganizationName: DR. PAMELA S. HODGES MD PSC
LastName:  
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MiddleName:  
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Credential:  
OtherOrganizationName:  
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Mailing Information
Address1: 2605 KENTUCKY AVE
Address2: SUITE 304
City: PADUCAH
State: KY
PostalCode: 420033800
CountryCode: US
TelephoneNumber: 2705754555
FaxNumber: 2705754882
Practice Location
Address1: 2605 KENTUCKY AVE
Address2: SUITE 304
City: PADUCAH
State: KY
PostalCode: 420033800
CountryCode: US
TelephoneNumber: 2705754555
FaxNumber: 2705754882
Other Information
ProviderEnumerationDate: 06/26/2007
LastUpdateDate: 08/06/2015
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: HODGES
AuthorizedOfficialFirstName: PAMELA
AuthorizedOfficialMiddleName: SUE
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 2705754555
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X19018KYY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansObstetrics & Gynecology 

ID Information
IDTypeStateIssuerDescription
6419018405KY MEDICAID


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